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Effects of antihypertensive treatment in Asian populations: a meta-analysis of prospective randomized controlled studies (CARdiovascular protectioN group in Asia: CARNA).

Publication ,  Journal Article
Yano, Y; Briasoulis, A; Bakris, GL; Hoshide, S; Wang, J-G; Shimada, K; Kario, K
Published in: J Am Soc Hypertens
February 2014

To examine the effects of antihypertensive treatment on cardiovascular disease (CVD) in Asian populations, we systematically evaluated prospective randomized studies carried out in Asia (1991-2013). We identified 18 trials with 23,215 and 21,986 hypertensive patients in the intervention (ie, strict blood pressure [BP] lowering or add-on treatment) and reference groups, respectively (mean age, 65 years; follow-up duration, 3.2 years). Analysis was performed through 1) first subgroup: eight trials that compared active antihypertensive treatment with placebo or intensive with less intensive BP control and 2) second subgroup: 10 trials that compared different antihypertensive treatments. In the first subgroup analysis, BP was reduced from 160.3/87.3 mm Hg to 140.2/78.4 mm Hg in the intervention group with a -6.7/-2.2 mm Hg (P < .001) greater BP reduction than the reference group. Compared with the reference group, the intervention group had a lower risk of composite CVD events (odd ratio [OR], 0.73; 95% confidence interval [CI], 0.66-0.81), myocardial infarction (OR, 0.79; 95% CI, 0.63-1.0), stroke (OR, 0.71; 95% CI, 0.63-0.80), and CVD mortality (OR, 0.81; 95% CI, 0.68-0.97; all P ≤ .05). In the second subgroup analysis, no difference was found for any outcome between renin-angiotensin blockers and calcium-channel blockers or diuretics. The meta-regression line among the 18 trials indicated that a 10 mm Hg reduction in systolic BP was associated with a reduced risk for composite CVD events (-39.5%) and stroke (-30.0%). Our meta-analysis shows a benefit when a BP target of less than 140/80 mm Hg is achieved in Asian hypertensives. BP reduction itself, regardless of BP lowering agents, is important for achieving CVD risk reduction.

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Published In

J Am Soc Hypertens

DOI

EISSN

1878-7436

Publication Date

February 2014

Volume

8

Issue

2

Start / End Page

103 / 116

Location

United States

Related Subject Headings

  • Stroke
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Male
  • Hypertension
  • Humans
  • Female
  • Cardiovascular System & Hematology
 

Citation

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Yano, Y., Briasoulis, A., Bakris, G. L., Hoshide, S., Wang, J.-G., Shimada, K., & Kario, K. (2014). Effects of antihypertensive treatment in Asian populations: a meta-analysis of prospective randomized controlled studies (CARdiovascular protectioN group in Asia: CARNA). J Am Soc Hypertens, 8(2), 103–116. https://doi.org/10.1016/j.jash.2013.09.002
Yano, Yuichiro, Alexandros Briasoulis, George L. Bakris, Satoshi Hoshide, Ji-Guang Wang, Kazuyuki Shimada, and Kazuomi Kario. “Effects of antihypertensive treatment in Asian populations: a meta-analysis of prospective randomized controlled studies (CARdiovascular protectioN group in Asia: CARNA).J Am Soc Hypertens 8, no. 2 (February 2014): 103–16. https://doi.org/10.1016/j.jash.2013.09.002.
Yano Y, Briasoulis A, Bakris GL, Hoshide S, Wang J-G, Shimada K, et al. Effects of antihypertensive treatment in Asian populations: a meta-analysis of prospective randomized controlled studies (CARdiovascular protectioN group in Asia: CARNA). J Am Soc Hypertens. 2014 Feb;8(2):103–16.
Yano, Yuichiro, et al. “Effects of antihypertensive treatment in Asian populations: a meta-analysis of prospective randomized controlled studies (CARdiovascular protectioN group in Asia: CARNA).J Am Soc Hypertens, vol. 8, no. 2, Feb. 2014, pp. 103–16. Pubmed, doi:10.1016/j.jash.2013.09.002.
Yano Y, Briasoulis A, Bakris GL, Hoshide S, Wang J-G, Shimada K, Kario K. Effects of antihypertensive treatment in Asian populations: a meta-analysis of prospective randomized controlled studies (CARdiovascular protectioN group in Asia: CARNA). J Am Soc Hypertens. 2014 Feb;8(2):103–116.
Journal cover image

Published In

J Am Soc Hypertens

DOI

EISSN

1878-7436

Publication Date

February 2014

Volume

8

Issue

2

Start / End Page

103 / 116

Location

United States

Related Subject Headings

  • Stroke
  • Risk Assessment
  • Randomized Controlled Trials as Topic
  • Outcome Assessment, Health Care
  • Myocardial Infarction
  • Male
  • Hypertension
  • Humans
  • Female
  • Cardiovascular System & Hematology