Antihypertensive drug effects according to the pretreatment self-measured home blood pressure: the HOMED-BP study
Year: 2020
Type: article
Abstract: OBJECTIVES: To clarify whether or not the antihypertensive drug effect is proportional to the baseline pretreatment self-measured home blood pressure (HBP) in accordance with the law of initial value (Wilder's law). DESIGN: A post-hoc analysis of a multicentre clinical trial. SETTING: Outpatients across Japan with mild-to-moderate essential hypertension. PARTICIPANTS: Among 3518 randomised participants, 2423 who self-measured HBP during the pretreatment drug-free period (10-28 days after starting fixed-dose antihypertensive monotherapy) with a mean 7.0 years follow-up were eligible. MAIN OUTCOME MEASURES: We analysed individual HBP readings during pretreatment and monotherapy. RESULTS: The day-to-day HBP during both the pretreatment period and monotherapy period remains almost the same throughout each period; the results were consistent, regardless of the pretreatment HBP. Following monotherapy, the reduction in the HBP increased by 2.2 mm Hg (95% CI: 1.8 to 2.5 mm Hg) per 10 mm Hg pretreatment HBP increase, up to 11.0 mm Hg (95% CI: 9.9 to 12.0 mm Hg) among patients with an HBP ≥165 mm Hg during pretreatment. Among the 1005 patients receiving low-dose monotherapy (defined daily dose: 0.5 units), the reduction peaked at 8.9-9.1 mm Hg in those with pretreatment HBP 155-164 mm Hg and ≥165 mm Hg (p=0.88). CONCLUSIONS: According to Wilder's law, the HBP reduction due to fixed-dose monotherapy was proportional to the pretreatment HBP without any regression to the mean phenomenon. With low-dose antihypertensive drugs, however, the HBP reduction peaked in patients with a high pretreatment HBP, indicating the need for such patients to receive a sufficient amount of antihypertensive drug medication at the initial treatment. TRIAL REGISTRATION: UMIN Clinical Trial Registry (http://www.umin.ac.jp/ctr), Unique identifier: C000000137.
Source: BMJ Open
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,839
Awards: G1029220155, G2656564951, G3544521570, Early prevention strategy on lifestyle-related diseases regarding DOHaD based on self-measured home blood pressure, G637501209, G660014893, Improvement of predictive power on cardiovascular disease risk by introducing ECG-gated fundus imaging system, G7200812282, Integration of out-of-office blood pressure for investigating comprehensive risk on cardiovascular complications., The maximam effect and the velocity of antihypertensive effects of drugs for hypertension determined by home blood pressuremeasurements, Population studies regarding genetic background on progression of hypertension and antihypertensive drug effect based on self-measured home blood pressure, The international collaborative pharmacoepidemiological study on drugs for the treatment of lifestyle-related diseases.
OpenAlex ID: W3112516221