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The lower, the better? : fractional polynomials meta-regression of blood pressure reduction on stroke risk

Hisato Takagi1, Takuya Umemoto

  • 1Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan, kfgth973@ybb.ne.jp.

High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension
|May 25, 2013
PubMed

Insights

Lowering systolic blood pressure (SBP) significantly reduces stroke risk. However, excessive SBP reduction beyond 13.7 mmHg with single-drug therapy offers no additional stroke risk reduction in primary prevention.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Pharmacology
  • Epidemiology

Background:

  • Blood pressure (BP) lowering drugs significantly reduce stroke risk.
  • A 10 mmHg reduction in systolic BP (SBP) or 5 mmHg in diastolic BP is associated with a one-third reduction in stroke incidence.

Purpose of the Study:

  • To determine the optimal extent of BP lowering for stroke risk reduction.
  • To investigate potential limits to BP reduction benefits in primary prevention.

Main Methods:

  • Meta-regression analysis of 17 primary-prevention trials.
  • Utilized fractional polynomials for flexible, non-linear modeling of SBP reduction and stroke risk.
  • Calculated relative risks (RRs) for stroke incidence based on SBP reduction.

Main Results:

  • An inverse J-shaped dose-response relationship was observed between SBP reduction and stroke risk.
  • The nadir, or optimal point for stroke risk reduction, occurred at a 13.7 mmHg SBP reduction.
  • The best-fitting model showed a significant gain in deviance compared to a linear model.

Conclusions:

  • Single-drug therapy for BP lowering may have a threshold for stroke risk reduction.
  • Reductions in SBP exceeding 13.7 mmHg in primary prevention settings do not appear to offer further stroke risk benefits.
  • These findings suggest a potential limit to the benefits of intensive BP lowering with monotherapy.
Abstract

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