title: Cumulative in-trial and post-trial effects of blood pressure and lipid lowering: systematic review and meta-analysis.
abstract: Persistent long-term benefits after discontinuation of treatment have been suggested for blood pressure-lowering and lipid-lowering treatment. We conducted a systematic review to assess the long-term effects of blood pressure (BP) lowering (BPL) and lipid lowering on all-cause and cardiovascular mortality after discontinuation of randomized treatment.
  
  
  
  We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials. We included large-scale randomized controlled trials of BPL or lipid lowering of at least 1 year with post-trial follow-up. We identified 13 BPL trials with 48 892 participants and 10 lipid-lowering trials with 71 370 participants. Mean in-trial and post-trial follow-up was approximately 4 and 6 years, respectively.
  
  
  
  BP and lipid levels tended to come together soon in the post-trial period. There was significant benefit of BPL on all-cause mortality during the in-trial period (relative risk 0.85, 95% confidence interval 0.81-0.89), and significant, but attenuated, benefit during overall follow-up (0.91, 0.87-0.94). Likewise, lipid lowering with statins reduced the risk of all-cause mortality during the in-trial period (0.88, 0.81-0.95), and this effect persisted during overall follow-up (0.92, 0.87-0.97). Similar findings were observed for cardiovascular death. In BPL trials, the cumulative reduction in all-cause mortality was significantly lower in trials with at least 5 years of post-trial follow-up compared with those with less than 5 years, and a similar tendency was observed for lipid-lowering trials.
  
  
  
  Benefits of BPL and lipid lowering on all-cause and cardiovascular mortality were persistent, but attenuated, after discontinuation of randomized treatment, indicating the importance of continuing therapy.
authors.affiliation: aThe George Institute for Global Health, University of Sydney, Sydney, Australia bDepartment of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan cThe George Institute for Global Health, University of Oxford, Oxford, UK dDepartment of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hirakawa
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids