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Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses

BACKGROUND: Hypertension has been cited as the most common attributable risk factor for death worldwide, and in Canada more than one of every five adults had this diagnosis in 2007. In addition to different lifestyle modifications, such as diet and exercise, there exist many pharmaco-therapies from...

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Autores principales: Hutton, Brian, Tetzlaff, Jennifer, Yazdi, Fatemeh, Thielman, Justin, Kanji, Salmaan, Fergusson, Dean, Bjerre, Lise, Mills, Edward, Thorlund, Kristian, Tricco, Andrea, Straus, Sharon, Moher, David, Leenen, Frans HH
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701495/
https://www.ncbi.nlm.nih.gov/pubmed/23809864
http://dx.doi.org/10.1186/2046-4053-2-44
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author Hutton, Brian
Tetzlaff, Jennifer
Yazdi, Fatemeh
Thielman, Justin
Kanji, Salmaan
Fergusson, Dean
Bjerre, Lise
Mills, Edward
Thorlund, Kristian
Tricco, Andrea
Straus, Sharon
Moher, David
Leenen, Frans HH
author_facet Hutton, Brian
Tetzlaff, Jennifer
Yazdi, Fatemeh
Thielman, Justin
Kanji, Salmaan
Fergusson, Dean
Bjerre, Lise
Mills, Edward
Thorlund, Kristian
Tricco, Andrea
Straus, Sharon
Moher, David
Leenen, Frans HH
author_sort Hutton, Brian
collection PubMed
description BACKGROUND: Hypertension has been cited as the most common attributable risk factor for death worldwide, and in Canada more than one of every five adults had this diagnosis in 2007. In addition to different lifestyle modifications, such as diet and exercise, there exist many pharmaco-therapies from different drug classes which can be used to lower blood pressure, thereby reducing the risk of serious clinical outcomes. In moderate and severe cases, more than one agent may be used. The optimal mono- and combination therapies for mild hypertension and moderate/severe hypertension are unclear, and clinical guidelines provide different recommendations for first line therapy. The objective of this review is to explore the relative benefits and safety of different pharmacotherapies for management of non-diabetic patients with hypertension, whether of a mild or moderate to severe nature. METHODS/DESIGN: Searches involving MEDLINE and the Cochrane Database of Systematic Reviews will be used to identify related systematic reviews and relevant randomized trials. The outcomes of interest include myocardial infarction, stroke, incident diabetes, heart failure, overall and cardiovascular related death, and important side effects (cancers, depression, syncopal episodes/falls and sexual dysfunction). Randomized controlled trials will be sought. Two reviewers will independently screen relevant reviews, titles and abstracts resulting from the literature search, and also potentially relevant full-text articles in duplicate. Data will be abstracted and quality will be appraised by two team members independently. Conflicts at all levels of screening and abstraction will be resolved through team discussion. Random effect pairwise meta-analyses and network meta-analyses will be conducted where deemed appropriate. Analyses will be geared toward studying treatment of mild hypertension and moderate/severe hypertension separately. DISCUSSION: Our systematic review results will assess the extent of currently available evidence for single agent and multi-agent pharmacotherapies in patients with mild, moderate and severe hypertension, and will provide a rigorous and updated synthesis of a range of important clinical outcomes for clinicians, decision makers and patients. TRIAL REGISTRATION: PROSPERO Registration Number: CRD42013004459
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spelling pubmed-37014952013-07-05 Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses Hutton, Brian Tetzlaff, Jennifer Yazdi, Fatemeh Thielman, Justin Kanji, Salmaan Fergusson, Dean Bjerre, Lise Mills, Edward Thorlund, Kristian Tricco, Andrea Straus, Sharon Moher, David Leenen, Frans HH Syst Rev Protocol BACKGROUND: Hypertension has been cited as the most common attributable risk factor for death worldwide, and in Canada more than one of every five adults had this diagnosis in 2007. In addition to different lifestyle modifications, such as diet and exercise, there exist many pharmaco-therapies from different drug classes which can be used to lower blood pressure, thereby reducing the risk of serious clinical outcomes. In moderate and severe cases, more than one agent may be used. The optimal mono- and combination therapies for mild hypertension and moderate/severe hypertension are unclear, and clinical guidelines provide different recommendations for first line therapy. The objective of this review is to explore the relative benefits and safety of different pharmacotherapies for management of non-diabetic patients with hypertension, whether of a mild or moderate to severe nature. METHODS/DESIGN: Searches involving MEDLINE and the Cochrane Database of Systematic Reviews will be used to identify related systematic reviews and relevant randomized trials. The outcomes of interest include myocardial infarction, stroke, incident diabetes, heart failure, overall and cardiovascular related death, and important side effects (cancers, depression, syncopal episodes/falls and sexual dysfunction). Randomized controlled trials will be sought. Two reviewers will independently screen relevant reviews, titles and abstracts resulting from the literature search, and also potentially relevant full-text articles in duplicate. Data will be abstracted and quality will be appraised by two team members independently. Conflicts at all levels of screening and abstraction will be resolved through team discussion. Random effect pairwise meta-analyses and network meta-analyses will be conducted where deemed appropriate. Analyses will be geared toward studying treatment of mild hypertension and moderate/severe hypertension separately. DISCUSSION: Our systematic review results will assess the extent of currently available evidence for single agent and multi-agent pharmacotherapies in patients with mild, moderate and severe hypertension, and will provide a rigorous and updated synthesis of a range of important clinical outcomes for clinicians, decision makers and patients. TRIAL REGISTRATION: PROSPERO Registration Number: CRD42013004459 BioMed Central 2013-06-28 /pmc/articles/PMC3701495/ /pubmed/23809864 http://dx.doi.org/10.1186/2046-4053-2-44 Text en Copyright © 2013 Hutton et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Protocol
Hutton, Brian
Tetzlaff, Jennifer
Yazdi, Fatemeh
Thielman, Justin
Kanji, Salmaan
Fergusson, Dean
Bjerre, Lise
Mills, Edward
Thorlund, Kristian
Tricco, Andrea
Straus, Sharon
Moher, David
Leenen, Frans HH
Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses
title Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses
title_full Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses
title_fullStr Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses
title_full_unstemmed Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses
title_short Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses
title_sort comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses
topic Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701495/
https://www.ncbi.nlm.nih.gov/pubmed/23809864
http://dx.doi.org/10.1186/2046-4053-2-44
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