EFFECT OF ANTIHYPERTENSIVE DRUG-TREATMENT ON CARDIOVASCULAR OUTCOMES IN WOMEN AND MEN - A METAANALYSIS OF INDIVIDUAL PATIENT DATA FROM RANDOMIZED, CONTROLLED TRIALS

Background: Trials of drug therapy for hypertension have shown that su ch therapy has a clear overall benefit in preventing cardiovascular di sease. Although these trials have included slightly more women than me n, it is still not clear whether treatment benefit is similar for both sexes. Objective: To quantify the average treatment effect in both se xes and to determine whether available data show significant differenc es in treatment effect between women and men. Design: Subgroup meta-an alysis of individual patient data according to sex. Analysis was based on seven trials from the INDANA (INdividual Data ANalysis of Antihype rtensive intervention trials) database and was adjusted for possible c onfounders. Patients: 20 802 women and 19 975 men recruited between 19 72 and 1990. Interventions: Primarily beta-blockers and thiazide diure tics. Results: In women, treatment effect was statistically significan t for stroke (fatal strokes and all strokes) and for major cardiovascu lar events. In men, it was statistically significant for all categorie s of events (total and specific mortality, all coronary events, all st rokes, and major cardiovascular events). The odds ratios for any categ ory of event did not differ significantly between men and women. In ab solute terms, the benefit in women was seen primarily for strokes; in men, treatment prevented as many coronary events as strokes. Graphical analyses suggest that these results Could be completely explained by the difference in untreated risk. Conclusions: In terms of relative ri sk, treatment benefit did not differ between women and men. The absolu te risk reduction attributable to treatment seemed to depend on untrea ted risk. These findings underline the need to predict accurately the untreated cardiovascular risk of an individual person in order to rati onalize and individualize antihypertensive treatment.