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- Title
Health Outcomes Associated With Various Antihypertensive Therapies Used as First-Line Agents: A Network Meta-analysis.
- Authors
Psaty, Bruce M.; Lumley, Thomas; Furberg, Curt D.; Schellenbaum, Gina; Pahor, Marco; Alderman, Michael H.; Weiss, Noel S.
- Abstract
Context: Establishing relative benefit or harm from specific antihypertensive agents is limited by the complex array of studies that compare treatments. Network meta-analysis combines direct and indirect evidence to better define risk or benefit. Objective: To summarize the available clinical trial evidence concerning the safety and efficacy of various antihypertensive therapies used as first-line agents and evaluated in terms of major cardiovascular disease end points and all-cause mortality. Data Sources and Study Selection: We used previous meta-analyses, MEDLINE searches, and journal reviews from January 1995 through December 2002. We identified long-term randomized controlled trials that assessed major cardiovascular disease end points as an outcome. Eligible studies included both those with placebo-treated or untreated controls and those with actively treated controls. Data Extraction: Network meta-analysis was used to combine direct within-trial between-drug comparisons with indirect evidence from the other trials. The indirect comparisons, which preserve the within-trial randomized findings, were constructed from trials that had one treatment in common. Data Synthesis: Data were combined from 42 clinical trials that included 192 478 patients randomized to 7 major treatment strategies, including placebo. For all outcomes, low-dose diuretics were superior to placebo: coronary heart disease (CHD; RR, 0.79; 95% confidence interval [CI], 0.69-0.92); congestive heart failure (CHF; RR, 0.51; 95% CI, 0.42-0.62); stroke (RR, 0.71; 0.63-0.81); cardiovascular disease events (RR, 0.76; 95% CI, 0.69-0.83); cardiovascular disease mortality (RR, 0.81; 95% CI, 0.73-0.92); and total mortality (RR, 0.90; 95% CI, 0.84-0.96). None of the first-line treatment strategies–β-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), α-blockers, and angiotensin receptor blockers–was significantly better than low-dose...
- Subjects
ANTIHYPERTENSIVE agents; DRUG therapy; CARDIOVASCULAR diseases; HEART diseases
- Publication
JAMA: Journal of the American Medical Association, 2003, Vol 289, Issue 19, p2534
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.289.19.2534