Monitoring initial response to Angiotensin-converting enzyme inhibitor-based regimens: An individual patient data meta-analysis from randomized, placebo-controlled trials

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

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Abstract

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.

Original languageEnglish
Pages (from-to)533-9
Number of pages7
JournalHypertension
Volume56
Issue number3
DOIs
Publication statusPublished - Sep 2010
Externally publishedYes

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Angiotensin-Converting Enzyme Inhibitors
Meta-Analysis
Randomized Controlled Trials
Placebos
Blood Pressure
Blood Pressure Monitors

Cite this

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. / Monitoring initial response to Angiotensin-converting enzyme inhibitor-based regimens : An individual patient data meta-analysis from randomized, placebo-controlled trials. In: Hypertension. 2010 ; Vol. 56, No. 3. pp. 533-9.
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title = "Monitoring initial response to Angiotensin-converting enzyme inhibitor-based regimens: An individual patient data meta-analysis from randomized, placebo-controlled trials",
abstract = "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.",
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Bell, KJL, Hayen, A, Macaskill, P, Craig, JC, Neal, BC, Fox, KM, Remme, WJ, Asselbergs, FW, van Gilst, WH, Macmahon, S, Remuzzi, G, Ruggenenti, P, Teo, KK & Irwig, L 2010, 'Monitoring initial response to Angiotensin-converting enzyme inhibitor-based regimens: An individual patient data meta-analysis from randomized, placebo-controlled trials' Hypertension, vol. 56, no. 3, pp. 533-9. https://doi.org/10.1161/HYPERTENSIONAHA.110.152421

Monitoring initial response to Angiotensin-converting enzyme inhibitor-based regimens : An individual patient data meta-analysis from randomized, placebo-controlled trials. / 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.

In: Hypertension, Vol. 56, No. 3, 09.2010, p. 533-9.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - An individual patient data meta-analysis from randomized, placebo-controlled trials

AU - Bell, Katy J L

AU - Hayen, Andrew

AU - Macaskill, Petra

AU - Craig, Jonathan C

AU - Neal, Bruce C

AU - Fox, Kim M

AU - Remme, Willem J

AU - Asselbergs, Folkert W

AU - van Gilst, Wiek H

AU - Macmahon, Stephen

AU - Remuzzi, Giuseppe

AU - Ruggenenti, Piero

AU - Teo, Koon K

AU - Irwig, Les

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N2 - 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.

AB - 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.

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