Patients receiving an antihypertensive drug without HF or other CVDs.
Patients with mild or moderate essential hypertension and patient age > 18 years. The average age was around 50.
Hypertensive patients, generally without a history of CHD, stroke, DM or RD. Age range was 46-71. Initial SBP range was 136-173 mmHg.
Patients had elevated blood pressure without angina and congestive HF, but with prior MI or stroke as long as they were not recent. The average age was 62 years old.
Interventions
A specified fixed standard dose of any Ds, BBs, CCBs, ACEIs and ARBs. Trials that in which the dose of the drug was not fixed but titrated were excluded.
Ds, BBs, CCBs, ACEIs, ARBs and the renin inhibitor (Aliskiren) where the drugs were used as monotherapy, either at a fixed daily dosage or in increasing dosages.
Ds, BBs, CCBs, ACEIs and ARBs.
Ds, BBs, CCBs and ACEIs.
Initial combined therapies with drug classes not in the defined categories and supplemental drugs from other drug classes of interest were limitedly allowed.
Outcome
The average placebo-adjusted reduction (and 95% CI) in blood pressure over 24 hours and 95% CI.
Weighted average reductions (and 95% CI) in SBP over a period of 8-12 weeks.
Mean (and 95% CI) placebo-subtracted SBP reduction over a period of 4-12 weeks.
The weighted mean difference (and 95% CI) between active drug arm and placebo arm at one year or the earliest time after one year.
SBP lowering effect
Ds
8.8 [8.3 9.4]
19.2 [18.0 20.3]
7.3 [6.4 8.2]
13.04 [12.55 13.53]
BBs
9.2 [8.6 9.9]
14.8 [13.7 15.9]
9.3 [8.1 10.4]
9.51 [8.85 10.16]
CCBs
8.8 [8.3 9.2]
16.4 [15.8 17.0]
8.4 [7.2 9.7]
8.90 [7.66 10.14]
ACEIs
8.5 [7.9 9.0]
15.6 [13.6 17.6]
6.8 [6.0 7.7]
21.14 [19.15 23.13]
1) Two studies in grey were finally used to estimate the SBP lowering effect over time.
After the initiation of treatment, SBP generally shows a pattern to decrease rapidly in three months and then to stabilize long-term[2, 316, 317]. Based on the observed SBP lowering effects in three months from Wald et al’s review and one year from Wright et al’s review, the gradually reduced SBP lowering effect between three months and one year were assumed using the following logarithmic function (see Table 5.):
