Monitoring Initial Response to Angiotensin-Converting Enzyme Inhibitor-Based Regimens An Individual Patient Data Meta-Analysis From Randomized, Placebo-Controlled Trials

作者：Bell Katy J L^*; Hayen Andrew; Macaskill Petra; Craig Jonathan C; Neal Bruce C; Fox Kim M; Remme Willem J; Asselbergs Folkert W; van Gilst Wiek H; MacMahon Stephen; Remuzzi Giuseppe; Ruggenenti Piero; Teo Koon K; Irwig Les

来源：Hypertension, 2010, 56(3): 533-U429.

DOI：10.1161/HYPERTENSIONAHA.110.152421

• blood pressure
• angiotensin-converting enzyme inhibitors
• treatment outcome
• models
• statistical
• reproducibility of results
• cardiovascular disease
• stroke

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.)

• 出版日期2010-9