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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    Bell, K. J. L., Hayen, A., Macaskill, P., Craig, J. C., Neal, B. C., Fox, K. M., Remme, W. J., Asselbergs, F. W., van Gilst, W. H., Macmahon, S., Remuzzi, G., Ruggenenti, P., Teo, K. K., & 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, 56(3), 533-9. https://doi.org/10.1161/HYPERTENSIONAHA.110.152421