Abstract
OBJECTIVE:To identify the drug specific effect of antihypertensive agents, on blood pressure (BP).(Figure is included in full-text article.)
DESIGN AND METHOD:Search strategyComprehensive electronic search of MEDLINE, EMBASE, Web of Science and Cochrane for trials published between 1995 and 2015. Cross-references of all retrieved manuscripts were also checked to identify additional trials.Selection criteriaRandomised controlled trials (RCTs) of antihypertensive agents (angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), diuretics (DIs) or beta-blockers (BBs)), with at least 100 randomized hypertensive participants and with a follow-up of at least 1 year.Data collection and analysisTwo authors independently selected the included trials, evaluated the risk of bias and retrieved the data on BP response. Meta-analyses were performed to summarise the pooled standardised mean difference (SMD) between treatment arms of included studies. BP response was documented as delta, single measure and repeated measures.
RESULTS:83 RCTs with 197,684 participants were identified, grouped as followsACEIs (37 RCTs) 36410; ARBs (34 RCTs) 20705; CCBs (46 RCTs) 73987; DIs (26 RCTs) 56727; and BBs (22 RCTs) 43617). CCBs were the most frequently prescribed antihypertensive agents for hypertension (27.30%). CCBs were superior to ACEIs in lowering BP (pooled SMD of −0.07 / −0.08 mmHg, P < 0.00001). Similarly, DIs were superior to ACEIs (−0.11 mmHg, p < 0.00001) and CCBs (−0.06 mmHg, p < 0.00001) in lowering Systolic BP. Additionally, ARBs were superior to BBs in lowering Systolic BP (−0.06, P = 0.001).
CONCLUSIONS:All anti-hypertensive drugs are not equal in reducing BP. BP response data from RCTs of different anti-hypertensive agents will guide physicians to select the appropriate drug to get the desired effect. CCBs should be the choice of first-line mono-therapy or second-line combination therapy as in most of the existing BP guidelines.