Journal
HYPERTENSION
Volume 56, Issue 3, Pages 533-U429Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.110.152421
Keywords
blood pressure; angiotensin-converting enzyme inhibitors; treatment outcome; models; statistical; reproducibility of results; cardiovascular disease; stroke
Categories
Funding
- Australian National Health and Medical Research Council [457212, 402764, 358395]
- Servier, France
- National Health and Medical Research Council of Australia
- Health Research Council of New Zealand
- Dutch Kidney Foundation
- Netherlands Heart Foundation
- Bristol- Myers Squibb
- Hoechst AG
- Abbott GmbH Co.
- Medical Research Council of Canada
- Merck Frosst Canada Inc.
- Pfizer
- Roche
- Takeda
- Amgen
- AstraZeneca
- GlaxoSmithKline
- Sanofi Aventis
- Tanabe
- Johnson Johnson
- Merck Schring Plough
- United Healthcare Group
- Novartis CV Therapeutics
- Daiichi-Sankyo
- Tanabe-Mistubishi
- CV Therapeutics
- Servier Laboratories
- Astra Zeneca
- Boehringer Ingelheim
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Most clinicians monitor blood pressure to estimate a patient's response to blood pressure-lowering therapy. However, the apparent change may not actually reflect the effect of the treatment, because a person's blood pressure varies considerably even without the administration of drug therapy. We estimated random background within-person variation, apparent between-person variation, and true between-person variation in blood pressure response to angiotensin-converting enzyme inhibitors after 3 months. We used meta-analytic mixed models to analyze individual patient data from 28 281 participants in 7 randomized, controlled trials from the Blood Pressure Lowering Trialists Collaboration. The apparent between-person variation in response was large, with SDs for change in systolic blood pressure/diastolic blood pressure of 15.2/8.5 mm Hg. Within-person variation was also large, with SDs for change in systolic blood pressure/diastolic blood pressure of 14.9/8.45 mm Hg. The true between-person variation in response was small, with SDs for change in systolic blood pressure/diastolic blood pressure of 2.6/1.0 mm Hg. The proportion of the apparent between-person variation in response that was attributed to true between-person variation was only 3% for systolic blood pressure and 1% for diastolic blood pressure. In conclusion, most of the apparent variation in response is not because of true variation but is a consequence of background within-person fluctuation in day-to-day blood pressure levels. Instead of monitoring an individual's blood pressure response, a better approach may be to simply assume the mean treatment effect. (Hypertension. 2010; 56: 533-539.)
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