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...
Autores principales: | , , , , , |
---|---|
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 |