BPLTTC

Blood Pressure Lowering Treatment Trialists' Collaboration







Background

The Blood Pressure Lowering Treatment Trialists Collaboration (BPLTTC) was initiated in 1995 as a collaboration between the Principal Investigators of all the major ongoing clinical trials of blood pressure-lowering agents at the time. The first cycle of analyses included 15 trials and over 74,000 individuals. There 14 trials that were added in the second cycle, which included over 162,000 individual participants in total. These phases in the collaboration were successful in providing reliable evidence for the benefits of blood pressure-lowering for the prevention of major cardiovascular outcomes. In 2014, the BPLTTC was extended and new trialists were invited to join the collaboration. The third and current phase of the collaboration now includes over 352,000 individuals from 51 trials. This resource offers an unprecedented opportunity to clarify uncertainties in blood pressure lowering treatment and provide clinically relevant findings in specific patient subgroups.

GOVERNANCE

The current cycle of the BPLTTC is coordinated by a reserach team based at Oxford University. Its work is governed by a Steering Committee consisting of select Principal Investigators of some of the largest trials included in the BPLTTC and chaired by Dr Kazem Rahimi at University of Oxford. The Steering Committee is responsible for general oversight of the BPLTTC and providing scientific leadership regarding all aspects of proposal development, analysis, interpretation and reporting. A wide network of collaborators contributes to all scientific activities and debates.

Funding

The BPLTTC was initially supported by grants from the pharmaceutical industry, including Astra Hassle AB, Bayer AG, Bristol-Myers Squibb Company, Glaxo Wellcome, Hoechst Marion Roussel, Knoll AG, Merck and Company, Pfizer Inc., Searle and Institut de Recherches Internationales Servier, as well as the British Heart Foundation. Since 2005, BPLTTC has not been funded by the pharmaceutical industry and has only been supported by peer reviewed sources, such as the National Health and Medical Research Council of Australia and the UK National Institute for Health Research (NIHR). In October 2018, the BPLTTC was awarded over £150,000 from the British Heart Foundation, with additional support from the NIHR Oxford Biomedical Research Centre and the Oxford Martin School, to investigate the stratified efficacy and safety of pharmacological blood pressure-lowering.

Projects

Age-specific effects of blood pressure-lowering for prevention of cardiovascular disease

Status: On-going analysis and manuscript preparation
Updated 27 March 2021

Elevated blood pressure is a well-known, modifiable risk factor for cardiovascular morbidity and mortality, for which antihypertensive medications play an essential role as cardio-protective agents. However, it is unclear if the benefits are consistently observed across a wide range of ages. Meta-analyses based on aggregate data are unable stratify by age at an individual level, and to control for competing events. A detailed individual patient data meta-analysis will provide in-depth analysis of blood pressure-lowering treatment effects on major cardiovascular events across a wide range of ages. With a trend towards ageing populations worldwide, an increasingly important question is whether or not treatment should be initiated in and continued into older ages, in particular when BP is not very high

Sex-specific effects of blood pressure-lowering pharmacotherapy for the prevention of cardiovascular disease

Status: On-going analysis and manuscript preparation
Updated 27 May 2021

Hypertension is becoming more prevalent in women particularly in older age, with evidence that indicates more women die from cardiovascular disease than men in these age group. Some studies suggested noticeable differences in the patterns and trends of, and the impact of some risk factors on, the onset of cardiovascular disease between women and men. While blood pressure-lowering with antihypertensive drugs are effective in reducing cardiovascular disease risk in both women and men, detailed comparsions between the sexes on the effects of blood pressure-lowering treatment and of specific antihypertensive drug classes on cardiovascular disease is less investigated. Existing evidence based on tabular meta-analyses is limited as such studies are unable stratify by sex at an individual level. We aim to investigate the effects of pharmacological blood pressure-lowering on cardiovascular disease risk, and compare the effects of different antihypertensive drug classes on this risk between women and men.

Blood pressure-lowering and risk of new-onset type 2 diabetes using evidence from genetic analysis and meta-analysis of randomised controlled trials

Status: Manuscript submitted
Updated 27 May 2021

Blood pressure-lowering is an established strategy for preventing micro-and macrovascular events in people with type 2 diabetes but its role in the prevention of diabetes itself is unclear. Previous studies of effects of different classes of blood pressure-lowering drugs on risk of diabetes have reported contradictory findings. Some have reported that beta-blockers and thiazide diuretics increased the risk, while renin-angiotensin system inhibitors decreased the risk of diabetes. However, limited sample size of studies based on an individual trial may make their findings unreliable. In this project, we aim to provide robust evidence on the effect of blood pressure-lowering drugs overall and by drug classes on risk of incident diabetes. We will conduct an individual participant meta-analysis of randomised controlled trials of blood pressure-lowering drug treatment effects on subsequent risk of type 2 diabetes. Then, we will complement this planned analysis with Mendelian randomisation experiments by using genetic variants associated with blood pressure and those associated with genes that encode the therapeutic target of each antihypertensive drug class as instruments in the analysis.

Blood pressure-lowering for the prevention of cardiovascular disease in persons with and without type 2 diabetes

Status: On-going analysis and manuscript preparation
Updated 27 May 2021

Blood pressure-lowering is an established strategy for preventing micro-and macrovascular events in people with type 2 diabetes but it remains unclear if there are treatment thresholds that should be considered nor there are differential effects across antihypertensive drug classes. Single trials may not have the statistical power to address these questions reliably, and aggregate meta-analyses are unable to stratify the analysis according to type 2 diabetes history. In this project, we will conduct an individual participant-level meta-analysis of trials on blood pressure-lowering treatment for the prevention of cardiovascular disease in people with and without type 2 diabetes, and examine these results across a wide range of baseline blood pressure levels. Moreover, we will compare any variation in the effects by antihypertensive drug classess in these participant subgroups.

Baseline characteristics and long-term changes in blood pressure in the third cycle of the BPLTTC

Status: Manuscript submitted
Updated 27 May 2021

The third cycle of the BPLTTC offers an opportunity to investigate, in more detail, the effects of pharmacologic lowering on long-term blood pressure across a number of patient groups. Considering the differences in follow-up duration across trials and the diversity in the patient populations being studies, the approach taken for standardisation of treatment effects might be relevant particularly in understanding overall and subgroup findings. Futher, the frequency of remeasurements of blood pressure vary across trials, which raises questions around comparability of blood pressure differences across the trials. We plan to obtain precise estimation of the effect of blood pressure-lowering treatment on long-term blood pressure overall and across patient subgroups, and to quantify these effects using different methods that include simply comparing blood pressure difference between treatment arms to methods that also account for between and within-person variability.

Effects of blood pressure-lowering drug treatment on cancer risk

Status: On-going analysis and manuscript preparation
27 May 2021

The evidence for the benefits of antihypertensive medication in the reduction of cardiovascular disease is clear, some studies raised the possibility of some adverse effects, such as the risk of developing cancer. There is no clear mechanism why we expect to see this increase in risk, as the hypothesised pathway is linked to the drug class (addressed in the project below) but not on BP-lowering effects. However, these suggested associations have been based on observational studies, hence, we examine this association using randomised evidence of BP-lowering trials.

Effects of antihypertensive medication initiation and intensification on cardiovascular disease and all-cause mortality among adults with white coat hypertension, masked hypertension, white coat effect and masked uncontrolled hypertension

Status: Funding being sought
27 May 2021

Several guidelines, including the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline and the 2018 European Society of Hypertension/European Society of Cardiology BP guideline, recommend measuring BP outside of the office setting and withholding the initiation and intensification of antihypertensive medication among those with white coat hypertension and white coat effect, respectively, and initiating and intensifying treatment among those with masked hypertension and masked uncontrolled hypertension, respectively. However, there are no data from large randomized outcomes trials testing whether initiating antihypertensive medication among adults with white coat hypertension and masked hypertension and intensifying treatment among those with white coat effect and masked uncontrolled hypertension reduces the risk for cardiovascular disease (CVD) or all-cause mortality. Adopting a published algorithm to define hypertension phenotypes, we will investigate these questions using the BPLTTC resource

Effects of blood pressure-lowering treatment on risk of cardiovascular disease in patients with chronic kidney disease

Status: Data acquisition
27 May 2021

Hypertension is a major risk factor for the development and progression of chronic kidney disease (CKD), irrespective of the underlying cause. Recent aggregate-data meta-analyses have provided conflicting evidence on the effects of BP-lowering treatment in patients with CKD. Therefore, the impact of BP reduction on progression of CKD and prevention of cardiovascular events remains uncertain. Furthermore, whether reducing albuminuria could be a proxy for prevention of cardiovascular disease also remains controversial. There is also limited evidence suggesting that some drug classes may afford greater cardiovascular protection and reduction of proteinuria. This project aims to investigate the effects of BP reduction in patients with CKD overall and stratified by drug class. The interaction of treatment with albuminuria/proteinuria will also be investigated.

Effects of blood pressure-lowering treatment on renal function and disease

Status: Data acquistion
27 May 2021

As BP lowering reduces renal perfusion pressure, it is expected and not unusual for estimated glomerular filtration rate to decrease by 10 to 20% in patients treated for hypertension. Although this decline is usually limited to the first few weeks of treatment and stabilizes thereafter, concerns about potentially increased risk of renal impairment and eventual progression to renal failure often limit BP lowering treatment. Therefore, this project aims to investigate the effects of BP-lowering treatment on renal function and disease, and examine any differential effects by drug class and baseline blood pressure. The interaction with baseline comorbidities including chronic kidney disease, diabetes and cardiovascular disease will also be investigated and subgroup analysis performed if significant interactions are found.

Effects of pharmacologic treatment to lower blood pressure on subsequent onset of fractures

Status: Data acquistion
27 May 2021

Some observational analyses have suggested that initiation of blood pressure lowering therapy is associated with an increased risk of fractures. However, these analyses are susceptible to confounding (sicker elderly patients being initiated on BP lowering medication). In contrast, an analysis of HYVET indicated that BP lowering in the elderly reduced the rate of fractures. An IPD meta-analysis will investigate the long-term effect of antihypertensive therapy on falls/fractures in more detail.

Blood pressure-lowering effects on the risk of new-onset peripheral vascular disease

Status: Data acquistion
27 May 2021

There have been observations that both low and high blood pressure may be associated with higher risk of peripheral vascular disease, particularly those involving lower extremities. Other have suggested that use of antihypertensive drugs may worsen existing leg ischaemia in people with known peripheral artery disease. Large-scale trials to examine the effects of pharmacologic lowering of blood pressure in those with and without this vascular condition is limted. This project wil examine the effects of blood pressure-lowering treatment on subsequent risk of peripheral vascular disease in people with and without this condition at baseline.

Pharmacotherapy to lower blood pressure and impact on cognitive function and dementia risk

Status: Data acquistion
27 May 2021

It has been observed that hypertension is associated with some level of impairment of cognitive function. It has been hypothesised that elevated blood pressure contributes to ischaemic damage of cerebral tissues particularly white matter regions that play a role in cognitive function. Over time, persistently elevated blood pressure may promote cognitive decline and increase the risk of dementia. Many of these studies have been based on observational studies, and evidence from intervention trials are limited and show conflicting results. To harness the strength of the collaboration, we will pool data across several trials with relevant data, and address questions on the impact of blood pressure-lowering treatment on cognitive function and risk of dementia.

Effects of antihypertensive drug classes on blood pressure dispersion

Status: On-going analysis and manuscript preparation
27 May 2021

Antihypertensive drug classes are thought to be similarly effective in lowering BP, but differences in their effects on the degree of dispersion of BP readings at follow-up visits suggest that some drug classes may control elevated blood pressure more effectively at higher levels than at lower levels of baseline blood pressure, thereby reducing dispersion, whereas others lower BP independently of baseline level, leaving dispersion unchanged. We will explore the class-specific effects on various indices of blood pressure dispersion and the dependence of reductions in dispersions on mean and maximum blood pressure level at baseline.

Effects of pharmacologic lowering of blood pressure on subsequent blood pressure variability

Status: Protocol development
27 May 2021

Antihypertensive drugs are effective in reducing blood pressure and consequently reduce the risk of cardiovascular disease. Others have also suggested that intra-individual variability in blood pressure is predictive of adverse cardiovascular outcomes. However, there is limited randomised evidence on the impact of antihypertensive treatment on blood pressure variability, and how this variability could influence subsequent cardiovascular disease risk. This investigation will answer these questions, and explore the consistency of these effects in people with different characteristics as defined by their age, sex and other factors.

Effects of blood pressure-lowering treatment on risk of atrial fibrillation

Status: Data acquisition
27 May 2021

As previously indicated, atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia and its incidence and prevalence are rising globally. Although hypertension doubles the risk of developing AF, there is uncertainty around whether antihypertensive treatment can effectively reduce the risk of AF. This project aims to understand the effects of antihypertensive drugs on new-onset and recurrent AF.

Assessing blood pressure-lowering pharmacotherapy based on cardiovascular risk as compared with baseline blood pressure level to prevent cardiovascular disease

Status: Data acquisition
11 June 2021

Decisions to initiate pharmacotherapy to lower blood pressure has been commonly based on baseline blood pressure level reaching a certain threshold, typically, 140 mmHg systolic and/or 90 diastolic blood pressure or higher. Recent findings from this collaboration showed that the relative reduction in cardiovascular risk is consistent across baseline levels, even at systolic blood pressure below 120 mmHg. It is unclear if treatment should be given to all even in this group which tend to have a low level of absolute cardiovascular disease risk. Earlier findings from the collaboration have also shown that an alternative, and potentially more effective, approach would be to assess predicted cardiovascular risk at baseline to guide treatment decisions. As the collaboration has currently accumulated a greater number of participants and cardiovascular events, we plan to investigate the relative and absolute effects of blood pressure reduction according to predicted cardovascular risk at baseline, and compare these effects based baseline blood pressure levels.

Efficacy and safety of blood pressure-lowering treatment in patients with multiple comorbidities

Status: Data acquisition
27 May 2021

Multimorbidity, defined as the presence of two or more diseases in the same patient, is a growing epidemic worldwide and it is also increasingly common in patients with cardiovascular disease. However, such patients have been typically excluded or underrepresented in clinical studies, and hence the balance of harms and benefits of blood pressure-lowering treatment in patients with multiple comorbidities remains poorly understood. Therefore, this project aims to investigate whether the efficacy and safety of antihypertensive treatment varies by number and ‘clusters’ of baseline comorbidities. Combining the large number of trials included in BPLTTC will allow overcoming the lack of power of individual trials to perform multiple subgroup analyses.

More than 360,000 participants

With > 360,000 participants included in the 52 collaborating trials, the BPLTTC is the largest single data resource of individual patient-level randomized clinical trial data.

Contributing Trials

AASK (African American Study of Kidney Disease and Hypertension)
ABCD (Appropriate Blood Pressure Control in Diabetes Trial) [Normotensive cohort]
ACCORD (Action to Control Cardiovascular Risk in Diabetes)
ACTIVE I (Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events)
ADVANCE (Action in Diabetes and Vascular Disease)
ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attacks Trial)
ANBP (The Australian National Blood Pressure Study)
ANBP2 (Second Australian National Blood Pressure Study)
ASCOT-BPLA (Anglo-Scandinavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm)
BENEDICT (Bergamo Nephrologic Diabetes Complications Trial)
CAMELOT (The Comparison of Amlodipine vs Enalapril to Limit Occurrences of Thrombosis)
CAPPP (Captopril Prevention Project)
CARDIO-SIS (CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica)
CASE-J (Candesartan Antihypertensive Survival Evaluation in Japan)
COLM (Combination of OLMesartan and calcium channel blocker or diuretic)
CONVINCE (Controlled Onset Verapamil Investigation of Cardiovascular End Points)
COPE (Combination Therapy of Hypertension to Prevent Cardiovascular Events)
DIABHYCAR (Non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril)
DUTCH-TIA (Dutch Transient Ischemic Attack Trial)
ECOST (Efficacy of Candesartan on Outcome in Saitama Trial)
ELSA (European Lacidipine Sudy on Atherosclerosis)
EUROPA (European trial on reduction of cardiac events with perindopril in stable coronary artery)
EWPHE (European Working Party on High Blood Pressure in the Elderly)
HDFP (Hypertension Detection Follow-up Program)
HIJ-CREATE (Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Heart Disease)
HOMED-BP (Hypertension Objective Treatment based on Measurement by Electrical Devices of Blood Pressure Study)

HOPE (Heart Outcomes Prevention Evaluation Study)
HYVET (Hypertension in the Very Elderly Trial)
IDNT (Irbesartan Diabetic Nephropathy Trial)
INSIGHT (International Nifedipine GITS Study: Intervention as a Goal for Hypertension Therapy)
INVEST (International Verapamil-Trandolapril Study)
JMIC-B (Japan Multicenter Investigation for Cardiovascular Diseases-B)
LIFE (Losartan Intervention for Endpoint Reduction in Hypertension Study)
MOSES (Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention)
NICS-EH (National Intervention Cooperative Study in Elderly Hypertensives)
NORDIL (Nordic Diltiazem Study)
ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial)
PART 2 (Prevention of Atherosclerosis with Ramipril Trial)
PEACE (Prevention of Events with Angiotensin Converting Enzyme Inhibition)
PREVEND-IT (Prevention of Renal and Vascular Endstage Disease Intervention Trial)
PREVENT (Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial)
PROFESS (Prevention Regimen for Efectively Avoiding Second Strokes) Perindopril Protection Against Recurrent Stroke Study)
PROGRESS (Perindopril Protection Against Recurrent Stroke Study)
SHEP (Systolic Hypertension in the Elderly Program)
SPRINT (Systolic Blood Pressure Intervention Trial)
STOP HYPERTENSION-2 (Swedish Trial in Old Patients with Hypertension-2)
SYST-EUR (Systolic Hypertension in Europe)
TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease)
UKPDS (UK Prospective Diabetes Study)
VALISH (Valsartan in Elderly Isolated Systolic Hypertension Study)
VALUE (Valsartan Antihypertensive Long-Term Use Evaluation)
VHAS (Verapamil in Hypertension and Atherosclerosis Study)

Steering Committee

Barry Davis

University of Texas
School of Public Health
USA

Carl J. Pepine

Department of Medicine
University of Florida
USA

John Chalmers

The George Institute for Global Health
University of New South Wales
Australia

Koon Teo

Population Health Research Institute
McMaster University
Canada

Kazem Rahimi (Chair)

Deep Medicine Reserach Programme
University of Oxford
UK

BPLTT Core Analytic Group at University of Oxford

Emma Copland Epidemiologist / Statistical Programmer
Zeinab Bidel Epidemiologist / Statistical Programmer

Milad Nazarzadeh Epidemiologist / DPhil candidate
Dexter Canoy Clinical Epidemiologist

Publications

Blood pressure-lowering treatment for the prevention of cardiovascular events in patients with atrial fibrillation: An individual participant data meta-analysis.

Blood Pressure Lowering Treatment Trialists’ Collaboration.
Lancet. 2021 May 1;397(10285):1625-1636. doi: 10.1016/S0140-6736(21)00590-0.

Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis.

Ana-Catarina Pinho-Gomes, Luis Azevedo, Emma Copland, Dexter Canoy, Milad Nazarzadeh, Rema Ramakrishnan, Eivind Berge, Johan Sundström, Dipak Kotecha, Mark Woodward, Koon Teo, Barry R Davis, John Chalmers, Carl J Pepine, Kazem Rahimi, Blood Pressure Lowering Treatment Trialists’ Collaboration.
PLoS Med. 2021 Jun 1;18(6):e1003599. doi:10.1371/journal.pmed.1003599.

Antihypertensive treatment and risk of cancer: an individual participant data meta-analysis.

Emma Copland, Dexter Canoy, Milad Nazarzadeh, Zeinab Bidel, Rema Ramakrishnan, Mark Woodward, John Chalmers, Koon K Teo, Carl J Pepine, Barry R Davis, Sverre Kjeldsen, Johan Sundström, Kazem Rahimi; Blood Pressure Lowering Treatment Trialists’ Collaboration.
Lancet Oncol. 2021 Apr;22(4):558-570. doi:10.1016/S1470-2045(21)00033-4.

Investigating the stratified efficacy and safety of pharmacological blood pressure-lowering: an overall protocol for individual patient-level data meta-analyses of over 300 000 randomised participants in the new phase of the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC).

Rahimi K, Canoy D, Nazarzadeh M, Salimi-Khorshidi G, Woodward M, Teo K, Davis BR, Chalmers J, Pepine CJ; Blood Pressure Lowering Treatment Trialists’ Collaboration.
BMJ Open. 2019 May 22;9(5):e028698. doi:10.1136/bmjopen-2018-028698.

Effects of blood pressure lowering on cardiovascular events, in the context of regression to the mean: a systematic review of randomized trials.

Salam A, Atkins E, Sundström J, Hirakawa Y, Ettehad D, Emdin C, Neal B, Woodward M, Chalmers J, Berge E, Yusuf S, Rahimi K, Rodgers A; Blood Pressure Lowering Treatment Trialists’ Collaboration.
J Hypertens. 2019 Jan;37(1):16-23. doi:10.1097/HJH.0000000000001994.

Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data.

Karmali KN, Lloyd-Jones DM, van der Leeuw J, Goff DC Jr, Yusuf S, Zanchetti A, Glasziou P, Jackson R, Woodward M, Rodgers A, Neal BC, Berge E, Teo K, Davis BR, Chalmers J, Pepine C, Rahimi K, Sundström J; Blood Pressure Lowering Treatment Trialists’ Collaboration.
PLoS Med. 2018 Mar 20;15(3):e1002538. doi:10.1371/journal.pmed.1002538.

Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials.

Blood Pressure Lowering Treatment Trialists' Collaboration, Ying A, Arima H, Czernichow S, Woodward M, Huxley R, Turnbull F, Perkovic V, Neal B.
Lancet. 2015 Mar 7;385(9971):867-74. doi:10.1016/S0140-6736(14)61171-5.

Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data.

Blood Pressure Lowering Treatment Trialists' Collaboration, Sundström J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D, Baigent C, Emberson J, Rahimi K, MacMahon S, Patel A, Perkovic V, Turnbull F, Neal B.
Lancet. 2014 Aug 16;384(9943):591-8. doi:10.1016/S0140-6736(14)61212-5.

Authors' reply to Ladapo and Ogedegbe.

Ninomiya T, Perkovic V; Blood Pressure Lowering Treatment Trialists’ Collaboration.
BMJ. 2014 Jan 15;348:g148. doi: 10.1136/bmj.g148. No abstract available.

Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials.

Blood Pressure Lowering Treatment Trialists' Collaboration, Ninomiya T, Perkovic V, Turnbull F, Neal B, Barzi F, Cass A, Baigent C, Chalmers J, Li N, Woodward M, MacMahon S.
BMJ. 2013 Oct 3;347:f5680. doi: 10.1136/bmj.f5680. Review.

The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials.

Czernichow S, Zanchetti A, Turnbull F, Barzi F, Ninomiya T, Kengne AP, Lambers Heerspink HJ, Perkovic V, Huxley R, Arima H, Patel A, Chalmers J, Woodward M, MacMahon S, Neal B; Blood Pressure Lowering Treatment Trialists' Collaboration.
J Hypertens. 2011 Jan;29(1):4-16. doi: 10.1097/HJH.0b013e32834000be.

Do men and women respond differently to blood pressure-lowering treatment? Results of prospectively designed overviews of randomized trials.

Turnbull F, Woodward M, Neal B, Barzi F, Ninomiya T, Chalmers J, Perkovic V, Li N, MacMahon S; Blood Pressure Lowering Treatment Trialists' Collaboration.
Eur Heart J. 2008 Nov;29(21):2669-80. doi: 10.1093/eurheartj/ehn427. Epub 2008 Oct 13. Review.

Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials.

Blood Pressure Lowering Treatment Trialists' Collaboration, Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, Bulpitt C, Chalmers J, Fagard R, Gleason A, Heritier S, Li N, Perkovic V, Woodward M, MacMahon S.
BMJ. 2008 May 17;336(7653):1121-3. doi: 10.1136/bmj.39548.738368.BE. Epub 2008 May 14. Review.

Blood pressure-dependent and independent effects of agents that inhibit the renin-angiotensin system.

Blood Pressure Lowering Treatment Trialists' Collaboration, Turnbull F, Neal B, Pfeffer M, Kostis J, Algert C, Woodward M, Chalmers J, Zanchetti A, MacMahon S.
J Hypertens. 2007 May;25(5):951-8. Erratum in: J Hypertens. 2007 Jul;25(7):1524.

Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials.

Turnbull F, Neal B, Algert C, Chalmers J, Chapman N, Cutler J, Woodward M, MacMahon S; Blood Pressure Lowering Treatment Trialists' Collaboration.
Arch Intern Med. 2005 Jun 27;165(12):1410-9.

Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials.

Turnbull F; Blood Pressure Lowering Treatment Trialists' Collaboration.
Lancet. 2003 Nov 8;362(9395):1527-35.