Cargando…

Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis

BACKGROUND: Hypertension is a disease with significant clinical and socio-economic consequences. The reduction in cardiovascular mortality and morbidity in patients treated for hypertension is directly related to the magnitude of blood pressure reduction. Diuretics have proven useful for the prevent...

Descripción completa

Detalles Bibliográficos
Autores principales: Filipova, Elena, Dineva, Stela, Uzunova, Katya, Pavlova, Velichka, Kalinov, Krassimir, Vekov, Toni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445912/
https://www.ncbi.nlm.nih.gov/pubmed/32838806
http://dx.doi.org/10.1186/s13643-020-01457-9
_version_ 1783574076189573120
author Filipova, Elena
Dineva, Stela
Uzunova, Katya
Pavlova, Velichka
Kalinov, Krassimir
Vekov, Toni
author_facet Filipova, Elena
Dineva, Stela
Uzunova, Katya
Pavlova, Velichka
Kalinov, Krassimir
Vekov, Toni
author_sort Filipova, Elena
collection PubMed
description BACKGROUND: Hypertension is a disease with significant clinical and socio-economic consequences. The reduction in cardiovascular mortality and morbidity in patients treated for hypertension is directly related to the magnitude of blood pressure reduction. Diuretics have proven useful for the prevention of cardiovascular complications in addition to a long history of safety and efficacy. The main aim for this meta-analysis is to compare the efficacy of the combination of angiotensin receptor blocker (ARB) and chlorthalidone (CTLD) to the combination of ARB and hydrochlorothiazide (HCTZ) in patients with hypertension. METHODS: A comprehensive literature search was conducted through electronic databases PubMed, MEDLINE, Scopus, PsyInfo, Cochrane, eLIBRARY.ru, http://ClinicalTrials.gov and http://www.clinicaltrialsregister.eu in July 2020 to identify studies that investigate the effect of the combination of angiotensin receptor blocker with chlorthalidone or hydrochlorothiazide on the systolic and diastolic blood pressure in patients with hypertension. Changes in systolic and diastolic blood pressure (BP) expressed as a weighted mean difference (WMD) were our primary outcomes. The random-effects method was chosen as the primary analysis and results were presented with a 95% confidence interval (CI). Sensitivity analysis was performed and bias was assessed. RESULTS: Our search returned 2745 titles. Of them, 51 full-text articles remained to be subjected to assessment. Comparisons of ARB/HCTZ versus ARB showed changes in BP of −6.89 (−8.09, −5.69) mmHg for systolic BP and − 3.67 (−4.15, −3.19) mmHg for diastolic BP. For the ARB/CTLD versus ARB/HCTZ comparison changes were − 6.30 (−7.30, −5.29) mmHg for systolic BP and − 3.57 (−4.17, 2.98) mmHg for diastolic BP. CONCLUSION: Our analysis suggests a small but significant favor for CTLD in blood pressure control when compared to HCTZ. We believe it should be considered as a valuable alternative for HCTZ and an option for fixed dose combinations with an ARB although further research is required.
format Online
Article
Text
id pubmed-7445912
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-74459122020-08-26 Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis Filipova, Elena Dineva, Stela Uzunova, Katya Pavlova, Velichka Kalinov, Krassimir Vekov, Toni Syst Rev Systematic Review Update BACKGROUND: Hypertension is a disease with significant clinical and socio-economic consequences. The reduction in cardiovascular mortality and morbidity in patients treated for hypertension is directly related to the magnitude of blood pressure reduction. Diuretics have proven useful for the prevention of cardiovascular complications in addition to a long history of safety and efficacy. The main aim for this meta-analysis is to compare the efficacy of the combination of angiotensin receptor blocker (ARB) and chlorthalidone (CTLD) to the combination of ARB and hydrochlorothiazide (HCTZ) in patients with hypertension. METHODS: A comprehensive literature search was conducted through electronic databases PubMed, MEDLINE, Scopus, PsyInfo, Cochrane, eLIBRARY.ru, http://ClinicalTrials.gov and http://www.clinicaltrialsregister.eu in July 2020 to identify studies that investigate the effect of the combination of angiotensin receptor blocker with chlorthalidone or hydrochlorothiazide on the systolic and diastolic blood pressure in patients with hypertension. Changes in systolic and diastolic blood pressure (BP) expressed as a weighted mean difference (WMD) were our primary outcomes. The random-effects method was chosen as the primary analysis and results were presented with a 95% confidence interval (CI). Sensitivity analysis was performed and bias was assessed. RESULTS: Our search returned 2745 titles. Of them, 51 full-text articles remained to be subjected to assessment. Comparisons of ARB/HCTZ versus ARB showed changes in BP of −6.89 (−8.09, −5.69) mmHg for systolic BP and − 3.67 (−4.15, −3.19) mmHg for diastolic BP. For the ARB/CTLD versus ARB/HCTZ comparison changes were − 6.30 (−7.30, −5.29) mmHg for systolic BP and − 3.57 (−4.17, 2.98) mmHg for diastolic BP. CONCLUSION: Our analysis suggests a small but significant favor for CTLD in blood pressure control when compared to HCTZ. We believe it should be considered as a valuable alternative for HCTZ and an option for fixed dose combinations with an ARB although further research is required. BioMed Central 2020-08-24 /pmc/articles/PMC7445912/ /pubmed/32838806 http://dx.doi.org/10.1186/s13643-020-01457-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Systematic Review Update
Filipova, Elena
Dineva, Stela
Uzunova, Katya
Pavlova, Velichka
Kalinov, Krassimir
Vekov, Toni
Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis
title Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis
title_full Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis
title_fullStr Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis
title_full_unstemmed Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis
title_short Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? A meta-analysis
title_sort combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide – which is the better alternative? a meta-analysis
topic Systematic Review Update
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445912/
https://www.ncbi.nlm.nih.gov/pubmed/32838806
http://dx.doi.org/10.1186/s13643-020-01457-9
work_keys_str_mv AT filipovaelena combiningangiotensinreceptorblockerswithchlorthalidoneorhydrochlorothiazidewhichisthebetteralternativeametaanalysis
AT dinevastela combiningangiotensinreceptorblockerswithchlorthalidoneorhydrochlorothiazidewhichisthebetteralternativeametaanalysis
AT uzunovakatya combiningangiotensinreceptorblockerswithchlorthalidoneorhydrochlorothiazidewhichisthebetteralternativeametaanalysis
AT pavlovavelichka combiningangiotensinreceptorblockerswithchlorthalidoneorhydrochlorothiazidewhichisthebetteralternativeametaanalysis
AT kalinovkrassimir combiningangiotensinreceptorblockerswithchlorthalidoneorhydrochlorothiazidewhichisthebetteralternativeametaanalysis
AT vekovtoni combiningangiotensinreceptorblockerswithchlorthalidoneorhydrochlorothiazidewhichisthebetteralternativeametaanalysis