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Special Report

Blood pressure-lowering drugs: essential therapy for some patients with normal blood pressure

Pages 771-775 | Published online: 10 Jan 2014

References

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  • ••Meta-analysis summarizing the results of alarge body of human investigations on the risks of disease. It establishes, beyond any reasonable doubt, that the real normal blood pressure is similar to those observed in nonacculturated populations — below 115/75 mmHg.
  • Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mmHg. J. Am. Med. Assoc. 202, 1028–1034 (1967).
  • •This trial is one of the foundations of modern medicine, demonstrating the strong benefit derived from the drug treatment of patients with severe hypertension.
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  • •Classical meta-analysis of the first clinical trials that demonstrated the benefits of blood pressure-lowering drugs at a wide range of blood pressure values.
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  • •Creative, systematic review of the evidence, demonstrating the close relationship between the intensity of blood pressure lowering and the reduction in the incidence of major cardiovascular events.
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  • ••Landmark trial that showed that diuretics(old and inexpensive antihypertensive drugs) are the most efficacious agents for starting the treatment of hypertension in a wide range of racial, age, and medical-condition groups.
  • The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl. J. Med. 342, 145–153 (2000).
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  • •Results of this trial should be urgently incorporated into clinical practice; the use of a diuretic and an ACE inhibitor is the most efficacious approach to prevent a new stroke in patients who have recovered from a previous one.
  • Fox KM. EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicenter trial (the EUROPA study). Lancet 362, 782–788 (2003).
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  • The SOLVD investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl. J. Med. 325, 669–677 (1991).
  • •One of several clinical trials that demonstrates the benefit of the use of angiotensin-converting enzyme inhibitors in patients with heart failure.
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  • Pitt B, Zannad F, Remme \X/J- et al The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aMactone evaluation study investigators. N Engl J. Med 341, 709–717 (1999).
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  • Psaty BM, Lumley T, Furberg CD et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. J. Am. Med. Assoc. 289, 2534–2544 (2003).
  • •New approach to the evidence, showing the advantage of diuretics over other classes of blood pressure-lowering drugs in the prevention of various cardiovascular events.

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