Updated meta-analytical approach to the efficacy of antihypertensive drugs in
reducing blood pressure.
Author(s): Baguet JP(1), Legallicier B, Auquier P, Robitail S.
Affiliation(s): Author information:
(1)Cardiology and Hypertension Unit, Grenoble University Hospital, Grenoble,
France. JPBAGUET@chu-grenoble.fr
Publication date & source: 2007, Clin Drug Investig. , 27(11):735-53
BACKGROUND AND OBJECTIVE: Despite advances in the treatment of hypertension,
control rates continue to be suboptimal in both Europe and the US. Strategies
that improve hypertension control are therefore urgently needed. This study aimed
to assess the relative efficacies of various antihypertensive drugs commonly used
in France in reducing systolic and diastolic blood pressure (SBP and DBP) by
using a meta-analytical approach. This update of a previously published
meta-analytical approach extends the number of drugs evaluated from 13 to 19.
METHODS: A total of 80 randomised, controlled trials published between 1973 and
2007 involving 10 818 patients were selected for inclusion in the meta-analytical
approach. Data were examined for 19 drugs, and 16 drugs were included in the
analysis: hydrochlorothiazide, indapamide sustained-release (SR), atenolol,
amlodipine, lercanidipine, manidipine, enalapril, ramipril, trandolapril,
candesartan cilexetil, irbesartan, losartan, olmesartan medoxomil, telmisartan,
valsartan and aliskiren. Weighted average reductions in SBP and DBP over a period
of 8-12 weeks were calculated for each drug from information on both the mean and
the variability in BP reduction. No trials evaluating furosemide, spironolactone
or cicletanine satisfied the inclusion criteria for this analysis.
RESULTS: The average weighted reductions in SBP over 8-12 weeks were most marked
with diuretics, and in particular indapamide SR 1.5 mg/day (mean change from
baseline -22.2mm Hg), which reduced SBP to a greater extent than any of the other
drugs evaluated (at any dosage considered). Average weighted reductions in DBP
were generally similar with all classes of antihypertensives and ranged from
-11.4mm Hg with the beta-adrenoceptor blocker atenolol and calcium channel
antagonists to -10.3mm Hg with the angiotensin II type 1 receptor antagonists.
CONCLUSION: This new analysis supports the results of the earlier investigation,
in that indapamide SR 1.5 mg/day appeared to be the most effective drug for
producing significant reductions in SBP within 8-12 weeks, which is an essential
element in optimising cardiovascular prevention among hypertensive patients. The
clinical application of these results should take into consideration all the
limitations discussed in this analysis.
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