Underestimation of the true benefits of antihypertensive treatment: An assessment of some important sources of error

Journal of Hypertension

Volumn 15, Issue 3, 1997, Pages 221-225

  Linjer, Erland ^a   Hansson, Lennart ^a  

^a UPPSALA UNIVERSITY   (Sweden)

Author keywords

Antihypertensive treatment; Intervention trials; Underestimation of benefit

Indexed keywords

ANTIHYPERTENSIVE AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT;

ANTIHYPERTENSIVE THERAPY; CARDIOVASCULAR DISEASE; CLINICAL TRIAL; CONGESTIVE HEART FAILURE; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; FOLLOW UP; HEART INFARCTION; HUMAN; HYPERTENSION; MAJOR CLINICAL STUDY; META ANALYSIS; MORBIDITY; MORTALITY; PATIENT COMPLIANCE; PRIORITY JOURNAL; REVIEW; STROKE;

EID: 0030968346     PISSN: 02636352     EISSN: None     Source Type: Journal    
DOI: 10.1097/00004872-199715030-00002     Document Type: Review

References (36)

1. Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, et al.: Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: over-view of randomised drug trials in their epidemiological context. Lancet 1990, 335:827-838.
2. Hansson L: What are we really achieving with long-term drug therapy? Am J Hypertens 1988, 1:414-420.
3. Hansson L: The benefits of lowering elevated blood pressure: a critical review of studies of cardiovascular morbidity and mortality in hypertension. J Hypertens 1996, 14:537-544.
4. Hansson L, Robertson JIS: Is hypertension treated adequately? Drugs 1987, 34 (suppl 3):1-6
5. Hansson L: Analysis of treatment outcomes - why is benefit not larger? Clin Exp Hypertens [A] 1989, 11:753-760.
6. Zanchetti A: Goals of antihypertensive treatment: prevention of cardiovascular events and prevention of organ damage. Blood Pressure 1992, 1:205-211.
7. Zanchetti A: Antihypertensive therapy. Pride and prejudice. [presidential lecture]. J Hypertens 1995, 13:1522-1528.
8. Metropolitan Life Insurance Company: Blood Pressure: Insurance Experience and its Implications. New York: Metropolitan Life Insurance Company; 1961.
9. Swales JD: Treating hypertension. J Hypertens 1996, 14:813-814.
10. Zanchetti A, Mancia G: Benefits and cost-effectiveness of antihypertensive therapy. The actuarial versus the intervention trial approach. [editor's corner]. J Hypertens 1996, 14:809-811.
11. Australian Therapeutic Trial in Mild Hypertension Management Committee: The Australian Therapeutic Trial in Mild Hypertension. Lancet 1980, i:261-1267.
12. Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester P-O: Morbidity and mortality in the Swedish trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991, 338:1281-1285.
13. SHEP Cooperative Research Group: Prevention of stroke by hypertensive drug therapy in older persons with isolated systolic hypertension: final results of the systolic hypertension in the elderly program. JAMA 1991, 265:3255-3264.
14. MRC Working Party: Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992, 304:405-412.
15. Hood B, Örndahl G, Björk S: Survival and mortality in malignant (grade IV) and grade III hypertension. Trends in consecutive, actively treated groups. Acta Med Scand 1970, 187:291-302.
16. Gudbrandsson T, Hansson L, Herlitz H, Andrén L: Malignant hypertension -improving prognosis in a rare disease. Acta Med Scand 1979, 206:495-499.
17. Amery A, Birkenhäger W, Brixko P, Bulpitt C, Clement D, De Schaepddryver A, et al.: Mortality and morbidity results from the European Working Party on High Blood Pressure in the elderly trial. Lancet 1985, i:1351-1354.
18. The IPPPSH Collaborative Group: Cardiovascular risk and risk factors in a randomized trial of treatment based on the beta-blocker oxprenolol: The International Prospective Primary Prevention Study in Hypertension (IPPPSH). J Hypertens 1985, 3:379-392.
19. Medical Research Council Working Party: MRC trial of treatment of mild hypertension: principal results. BMJ 1985, 29:97-104.
20. Wilhelmsen L, Berglund C, Elmfeldt D, Fitzsimons T, Holzgreve H, Hosie J, et al.: Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY Trial. J Hypertens 1987, 5:561-572.
21. Wikstrand J, Warnold I, Olsson C, Tuomilehto J, Elmfeldt D, Berglund G: Primary prevention with metoprolol in patients with hypertension. Mortality results from the MAPHY Study. JAMA 1988, 259:1976-1982.
22. Rosengren A, Wilhelmsen L, Berglund G, Elmfeldt D: Non-participants in a general population study of men, with special reference to social and alcoholic problems. Acta Med Scand 1987, 221:243-251.
23. Suhonen U, Reunänen A, Aromaa A, Knekt P, Pyörälä K: Four-year incidence of myocardial infarction and sudden coronary death in twelve Finnish population cohorts. Acta Med Scand 1985, 217:457-464.
24. van Bergen PF, Jonker JJ, Molhoek GP, van der Burg PH, van Domburg RT, Deckers JW, et al.: Characteristics and prognosis of non-participants of a multi-centre trial of long-term anticoagulant treatment after myocardial infarction. Int J Cardiol 1995, 49:135-141.
25. Hansson L, Zanchetti A: The Hypertension Optimal Treatment (HOT) Study: 12-month data on blood pressure and tolerability. With special reference to age and gender. Blood Pressure 1995, 4:313-319.
26. Anonymous: Patient compliance in therapeutic trials [editorial]. Lancet 1991, 337:823-824.
27. Goldsmith CH: The effect of differing compliance distribution on the planning and statistical analysis of therapeutic trials. In Compliance with Therapeutic Regimens. Edited by Sacket DL, Haynes RB. London: Johns Hopkins University Press; 1976:137-151.
28. Hansson L, Hedner T, Dahlöf B: Prospective Randomized Open Blinded End-point (PROBE) Study: a novel design for intervention trials. Blood Pressure 1992, 1:113-119.
29. Feinstein AR: Clinical Biostatistics XXX. Biostatistical problems in 'compliance bias'. Clin Pharmacol Ther 1974, 16:846-857.
30. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressure averaging 115 through 129 mmHg. JAMA 1967, 202:1028-1034.
31. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mmHg. JAMA 1970, 213:1143-1152.
32. Mohrer D, Dulberg CS, Wells GA: Statistical power, sample size, and their reporting in randomized controlled trials. JAMA 1994, 272:122-124.
33. Sytkowski P A, D'Agostino RB, Belanger AJ, Kannel WB: Secular trends in long-term sustained hypertension, long-term treatment and cardiovascular mortality. The Framingham Heart Study 1950 to 1990. Circulation 1996, 93:697-703.
34. Ribacke M, Tibblin G, Rosengren A, Eriksson H: Is hypertension changing? Blood pressure development in cohorts of 50-year old men between 1963 and 1993. Blood Pressure 1996, 5:133-137.
35. Hedner T, Hansson L, Jern S: What is happening to blood pressure? Blood Pressure 1996, 5:132-133.
36. Chobanian AV: Have long-term benefits of antihypertensive therapy been underestimated? Provocative findings from the Framingham Heart Study. Circulation 1996, 93:638-640.