 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 May 1997 | Volume 126 Issue 10 | Pages 761-767
Background: Trials of drug therapy for hypertension have shown that such therapy has a clear overall benefit in preventing cardiovascular disease. Although these trials have included slightly more women than men, it is still not clear whether treatment benefit is similar for both sexes.
Objective: To quantify the average treatment effect in both sexes and to determine whether available data show significant differences in treatment effect between women and men.
Design: Subgroup meta-analysis of individual patient data according to sex. Analysis was based on seven trials from the INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) database and was adjusted for possible confounders.
Patients: 20 802 women and 19 975 men recruited between 1972 and 1990.
Interventions: Primarily ß-blockers and thiazide diuretics.
Results: In women, treatment effect was statistically significant for stroke (fatal strokes and all strokes) and for major cardiovascular events. In men, it was statistically significant for all categories of events (total and specific mortality, all coronary events, all strokes, and major cardiovascular events). The odds ratios for any category of event did not differ significantly between men and women. In absolute terms, the benefit in women was seen primarily for strokes; in men, treatment prevented as many coronary events as strokes. Graphical analyses suggest that these results could be completely explained by the difference in untreated risk.
Conclusions: In terms of relative risk, treatment benefit did not differ between women and men. The absolute risk reduction attributable to treatment seemed to depend on untreated risk. These findings underline the need to predict accurately the untreated cardiovascular risk of an individual person in order to rationalize and individualize antihypertensive treatment.
Author and Article Information
(The INDANA Investigators)
ARTICLE
Effect of Antihypertensive Drug Treatment on Cardiovascular Outcomes in Women and Men
A Meta-Analysis of Individual Patient Data from Randomized, Controlled Trials
From Claude Bernard University, Lyon, France; London School of Hygiene and Tropical Medicine, London, United Kingdom; Bollington Medical Centre, Cheshire, United Kingdom; National Heart, Lung, and Blood Institute, Bethesda, Maryland; Lund University, Dalby/Lund, Sweden; UZ Pellenberg, Pellenberg, Belgium; Washington University, St. Louis, Missouri; and University of Miami, Miami, Florida.
Acknowledgments: The authors thank Margaret Haugh and Marie Elise Jean for linguistic help in preparing the manuscript.
Grant Support: The INDANA database was supported by grants from the Association pour la Promotion de la Recherche et de l'Evaluation en Therapeutique, the Societe Francaise d'Hypertension Arterielle, the Fondation pour la Recherche Medicale, and the Hospices Civils de Lyon.
Requests for Reprints: Francois Gueyffier, MD, Service de Pharmacologie Clinique, 162 Avenue Lacassagne, BP 3041, 69394 Lyon Cedex 03, France.
Current Author Addresses: Drs. Gueyffier and Boissel and Mr. Boutitie: Service de Pharmacologie Clinique, 162 Avenue Lacassagne, BP 3041, 69394 Lyon Cedex 03, France.
This article has been cited by other articles:
|
|
 |
|
  J. J. Thune, J. Signorovitch, L. Kober, E. J. Velazquez, J. J.V. McMurray, R. M. Califf, A. P. Maggioni, J. L. Rouleau, J. Howlett, S. Zelenkofske, et al. Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction Hypertension, January 1, 2008; 51(1): 48 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. K. Pedersen State of the Art Reviews: Health Benefits Related to Exercise in Patients With Chronic Low-Grade Systemic Inflammation American Journal of Lifestyle Medicine, August 1, 2007; 1(4): 289 - 298. [Abstract] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]
|
|
|
|
 |
|
 P A Mehta and M R Cowie Gender and heart failure: a population perspective Heart, May 1, 2006; 92(suppl_3): iii14 - iii18. [Full Text] [PDF]
|
|
|
|
 |
|
 G. L. Gierach, B. D. Johnson, C. N. Bairey Merz, S. F. Kelsey, V. Bittner, M. B. Olson, L. J. Shaw, S. Mankad, C. J. Pepine, S. E. Reis, et al. Hypertension, Menopause, and Coronary Artery Disease Risk in the Women's Ischemia Syndrome Evaluation (WISE) Study J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S50 - S58. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Williams Recent hypertension trials: Implications and controversies J. Am. Coll. Cardiol., March 15, 2005; 45(6): 813 - 827. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Fleming, E. P. Whitlock, T. L. Beil, and F. A. Lederle Screening for Abdominal Aortic Aneurysm: A Best-Evidence Systematic Review for the U.S. Preventive Services Task Force Ann Intern Med, February 1, 2005; 142(3): 203 - 211. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Lloyd-Jones, E. P. Leip, M. G. Larson, R. S. Vasan, and D. Levy Novel Approach to Examining First Cardiovascular Events After Hypertension Onset Hypertension, January 1, 2005; 45(1): 39 - 45. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Wassertheil-Smoller, B. Psaty, P. Greenland, A. Oberman, T. Kotchen, C. Mouton, H. Black, A. Aragaki, and M. Trevisan Association Between Cardiovascular Outcomes and Antihypertensive Drug Treatment in Older Women JAMA, December 15, 2004; 292(23): 2849 - 2859. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Gluckman, B. Baranowski, M. D. Ashen, C. A. Henrikson, M. McAllister, J. B. Braunstein, and R. S. Blumenthal A Practical and Evidence-Based Approach to Cardiovascular Disease Risk Reduction Arch Intern Med, July 26, 2004; 164(14): 1490 - 1500. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Christensen, M. Willmot, J. Leonardi-Bee, and P. M.W. Bath The Timing of the Blood Pressure Measurement May Affect the Result in Patients With Acute Stroke Hypertension, June 1, 2004; 43(6): e36 - e36. [Full Text] [PDF]
|
|
|
|
 |
|
 C. M.M. Lawes, D. A. Bennett, V. L. Feigin, and A. Rodgers Blood Pressure and Stroke: An Overview of Published Reviews Stroke, April 1, 2004; 35(4): 1024 - 1033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M.M. Lawes, D. A. Bennett, V. L. Feigin, and A. Rodgers Blood Pressure and Stroke: An Overview of Published Reviews Stroke, March 18, 2004; 01.STR.0000126208.14181.D. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Emberson, P. Whincup, R. Morris, M. Walker, and S. Ebrahim Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease Eur. Heart J., March 2, 2004; 25(6): 484 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M.M. Lawes, D. A. Bennett, V. L. Feigin, and A. Rodgers Blood Pressure and Stroke: An Overview of Published Reviews Stroke, March 1, 2004; 35(3): 776 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. U. Buzdar, P. Hietanen, M. Makela, N. Shahab, S. R. Harris, S. Hellman, D. Hellman, P. E. Goss, J. N. Ingle, J. L. Pater, et al. Letrozole in Breast Cancer N. Engl. J. Med., February 12, 2004; 350(7): 727 - 730. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Oparil Improving outcomes for women after coronary artery bypass grafting: A case for prevention J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1704 - 1706. [Full Text] [PDF]
|
|
|
|
|
|
A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Marshall Coronary heart disease prevention: insights from modelling incremental cost effectiveness BMJ, November 29, 2003; 327(7426): 1264. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Brindle, J. Emberson, F. Lampe, M. Walker, P. Whincup, T. Fahey, and S. Ebrahim Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study BMJ, November 29, 2003; 327(7426): 1267. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Lederle Ultrasonographic Screening for Abdominal Aortic Aneurysms Ann Intern Med, September 16, 2003; 139(6): 516 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Marshall and A. Rouse Resource implications and health benefits of primary prevention strategies for cardiovascular disease in people aged 30 to 74: mathematical modelling study BMJ, July 27, 2002; 325(7357): 197 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Boutitie, F. Gueyffier, S. Pocock, R. Fagard, J. P. Boissel, and for the INDANA Project Steering Committee J-Shaped Relationship between Blood Pressure and Mortality in Hypertensive Patients: New Insights from a Meta-Analysis of Individual-Patient Data Ann Intern Med, March 19, 2002; 136(6): 438 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E Roeters van Lennep, H.T. Westerveld, D.W. Erkelens, and E. E van der Wall Risk factors for coronary heart disease: implications of gender Cardiovasc Res, February 15, 2002; 53(3): 538 - 549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Vasan, M. G. Larson, E. P. Leip, J. C. Evans, C. J. O'Donnell, W. B. Kannel, and D. Levy Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease N. Engl. J. Med., November 1, 2001; 345(18): 1291 - 1297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J Pocock, V. McCormack, F. Gueyffier, F. Boutitie, R. H Fagard, and J.-P. Boissel A score for predicting risk of death from cardiovascular disease in adults with raised blood pressure, based on individual patient data from randomised controlled trials BMJ, July 14, 2001; 323(7304): 75 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Padwal, S. E Straus, and F. A McAlister Evidence based management of hypertension: Cardiovascular risk factors and their effects on the decision to treat hypertension: evidence based review BMJ, April 21, 2001; 322(7292): 977 - 980. [Full Text]
|
|
|
|
 |
|
 R. L. Ferrer, B. M. Sibai, C. D. Mulrow, E. Chiquette, K. R. Stevens, and J. Cornell MANAGEMENT OF MILD CHRONIC HYPERTENSION DURING PREGNANCY: A REVIEW Obstet. Gynecol., November 1, 2000; 96(5): 849 - 860. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Wassertheil-Smoller, G. Anderson, B. M. Psaty, H. R. Black, J. Manson, N. Wong, J. Francis, R. Grimm, T. Kotchen, R. Langer, et al. Hypertension and Its Treatment in Postmenopausal Women : Baseline Data from the Women's Health Initiative Hypertension, November 1, 2000; 36(5): 780 - 789. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. McAlister, A. M. O'Connor, G. Wells, S. A. Grover, and A. Laupacis When should hypertension be treated? The different perspectives of Canadian family physicians and patients Can. Med. Assoc. J., August 1, 2000; 163(4): 403 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Baker, P. Priest, and R. Jackson Using thresholds based on risk of cardiovascular disease to target treatment for hypertension: modelling events averted and number treated BMJ, March 11, 2000; 320(7236): 680 - 685. [Abstract] [Full Text]
|
|
|
|
|
|
J. Robson, K. Boomla, B. Hart, and G. Feder Estimating cardiovascular risk for primary prevention: outstanding questions for primary care BMJ, March 11, 2000; 320(7236): 702 - 704. [Full Text]
|
|
|
|
|
|
D. M. Lloyd-Jones, J. C. Evans, M. G. Larson, C. J. O'Donnell, P. W. F. Wilson, and D. Levy Cross-classification of JNC VI Blood Pressure Stages and Risk Groups in the Framingham Heart Study Arch Intern Med, October 11, 1999; 159(18): 2206 - 2212. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Levy, C. N. Bairey Merz, R. J. Cody, F. M. Fouad-Tarazi, C. K. Francis, M. A. Pfeffer, N. A. Scott, H. J. C. Swan, M. P. Taylor, and M. H. Weinberger Hypertension detection, treatment and control: A call to action for cardiovascular specialists J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1360 - 1362. [Full Text] [PDF]
|
|
|
|
 |
|
 P. August and S. Oparil Hypertension in Women J. Clin. Endocrinol. Metab., June 1, 1999; 84(6): 1862 - 1866. [Full Text]
|
|
|
|
 |
|
 M.-G. Bousser Stroke in Women : The 1997 Paul Dudley White International Lecture Circulation, February 2, 1999; 99(4): 463 - 467. [Full Text] [PDF]
|
|
|
|
|
|
E. Boerwinkle, P. A. Doris, and M. Fornage Field of Needs : The Genetics of Stroke Circulation, January 26, 1999; 99(3): 331 - 333. [Full Text] [PDF]
|
|
|
|
|
|
G. Gambassi, K. Lapane, A. Sgadari, F. Landi, P. Carbonin, A. Hume, L. Lipsitz, V. Mor, R. Bernabei, and for the SAGE Study Group Prevalence, Clinical Correlates, and Treatment of Hypertension in Elderly Nursing Home Residents Arch Intern Med, November 23, 1998; 158(21): 2377 - 2385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, and endorsed by the British Diabetic Association Joint British recommendations on prevention of coronary heart disease in clinical practice Heart, July 1, 1998; 80(90002): 1S - 29. [Full Text]
|
|
|
|
|
|
S. Oparil Pathophysiology of Sudden Coronary Death in Women : Implications for Prevention Circulation, June 2, 1998; 97(21): 2103 - 2105. [Full Text] [PDF]
|
|
|
|
|
|
L. Mosca, J. E. Manson, S. E. Sutherland, R. D. Langer, T. Manolio, E. Barrett-Connor, and E. Barrett-Connor Cardiovascular Disease in Women : A Statement for Healthcare Professionals From the American Heart Association Circulation, October 7, 1997; 96(7): 2468 - 2482. [Full Text]
|
|
|
|
 |
|
 Antihypertensive Therapy Benefits Women, Too Journal Watch Cardiology, June 20, 1997; 1997(620): 2 - 2. [Full Text]
|
|
|
|
 |
|
 ANTIHYPERTENSIVE THERAPY AND WOMEN Journal Watch (General), June 3, 1997; 1997(603): 3 - 3. [Full Text]
|
|
|
|
 |
|
 Antihypertensive Therapy: Women Benefit, Too Journal Watch Women's Health, June 1, 1997; 1997(601): 2 - 2. [Full Text]
|
|
Article
