Should β Blockers Remain First Choice in the Treatment of Primary Hypertension? A Meta-Analysis

Background: The 2007 ACC/AHA guideline on perioperative evaluation recommends perioperative β-blockers for non-cardiac surgery. However, some clinical trials seem to be at odds with these recommendations. Methods: PUBMED/EMBASE/CENTRAL search for randomized trials (RCTs) evaluating β-blockers for non-cardiac surgery. Efficacy outcomes of all-cause mortality, cardiovascular (CV) mortality, nonfatal MI, nonfatal stroke, heart failure, and myocardial ischemia (30 days), and safety outcomes of perioperative bradycardia, hypotension, and bronchospasm. Results: Among 33 RCTs which evaluated 12,306 patients, β-blockers were not associated with any significant reduction in the risk of all-cause mortality, CV mortality, or heart failure, but were associated with a 35% decrease in nonfatal MI, 64% decrease in myocardial ischemia at the expense of a 101% increase (Figure ) in nonfatal strokes. The beneficial effects were driven mainly by trials with high-bias risk, while analyses of low-biased trials showed a 28% and 101% increase in all-cause mortality and stroke with only a 29% and 59% reduction in nonfatal MI and 59%myocardial ischemia. For the safety outcomes, β-blockers were associated with a significantly increased risk of peri-op bradycardia and peri-op hypotension. Conclusions: In patients undergoing non-cardiac surgery, we estimate that treatment of 1000 patients with β-blockers results in 16 fewer nonfatal MI, but at the expense of 3 disabling strokes and 45 and 59 patients with clinically significant perioperative bradycardia and hypotension respectively, and suggests an increase in all-cause mortality.

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Nonselective β-Blockers and Survival in Patients With Cirrhosis and Ascites: A Systematic Review and Meta-analysis

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2016.01.012 ◽

2016 ◽

Vol 14 (8) ◽

pp. 1096-1104.e9 ◽

Cited By ~ 37

Author(s):

Sakkarin Chirapongsathorn ◽

Nelson Valentin ◽

Fares Alahdab ◽

Chayakrit Krittanawong ◽

Patricia J. Erwin ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Β Blockers

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Effects of Different Integrase Inhibitors on Body Weight in Patients with HIV/AIDS: A Network Meta-Analysis

10.21203/rs.3.rs-136545/v1 ◽

2020 ◽

Author(s):

Ruojing Bai ◽

Shiyun Lv ◽

Hao Wu ◽

Lili Dai

Keyword(s):

Body Weight ◽

Weight Gain ◽

Meta Analysis ◽

Biomedical Literature ◽

Cochrane Library ◽

Weight Changes ◽

Aids Patients ◽

First Choice ◽

Significant Difference ◽

Hiv Aids

Abstract Background: Global antiretroviral therapy has entered the era of integrase strand transfer inhibitor (INSTI). Because INSTIs have the advantages of high antiviral efficacy, rapid virus inhibition, and good tolerance, they have become the first choice in international acquired immunodeficiency syndrome (AIDS) treatment guidelines. However, they may also increase the risk of obesity. There are differences in the effects of different INSTIs on weight gain in Human immunodeficiency virus (HIV) infection / AIDS patients, but there is no evidence-based medical evidence. This study aimed to assess the effect of different INSTIs on body weight in HIV/AIDS patients.Methods: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database, and Wanfang databases were searched by computer to screen the relevant literature on INSTI treatment of HIV/AIDS patients, extract the data on weight changes in the literature, and perform network meta-analysis using Stata16.0 software.Results: Eight articles reported weight changes in HIV/AIDS patients, and weight gain was higher after treatment with dolutegravir (DTG) than with elvitegravir (EVG) in HIV/AIDS patients, and the difference was statistically significant [MD = 1.13, (0.18, 2.07)]. The network meta-analysis's consistency test results showed no overall and local inconsistency, and there was no significant difference in the results of the direct and indirect comparison (P > 0.05). The rank order of probability was DTG (79.2%) > Bictegravir (BIC) (77.9%) > Raltegravir (RAL) (33.2%) > EVG (9.7%), suggesting that DTG may be the INSTI drug that causes the most significant weight gain in HIV/AIDS patients.Conclusion: According to the literature data analysis, among the existing INSTIs, DTG may be the drug that causes the highest weight gain in HIV/AIDS patients, followed by BIC.

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Risk of congenital malformations in offspring of women using β‐blockers during early pregnancy: An updated meta‐analysis of observational studies

British Journal of Clinical Pharmacology ◽

10.1111/bcp.14561 ◽

2020 ◽

Author(s):

Yin Wu ◽

Jiang‐wei Yao ◽

Li‐jie Xu ◽

Miao Chen ◽

Long Wan

Keyword(s):

Early Pregnancy ◽

Congenital Malformations ◽

Observational Studies ◽

Meta Analysis ◽

Β Blockers

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290 COMPARATIVE EFFICACY OF CORTICOSTEROIDS FORMULATIONS FOR THE MANAGEMENT OF EOSINOPHILIC OESOPHAGITIS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS.

Diseases of the Esophagus ◽

10.1093/dote/doaa087.63 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

C Ma ◽

B Feagan ◽

D Claveau ◽

L Landry ◽

V Baribeau ◽

...

Keyword(s):

Topical Corticosteroid ◽

Controlled Trial ◽

Meta Analysis ◽

Adult Patients ◽

Eosinophilic Oesophagitis ◽

High Power Field ◽

Topical Corticosteroids ◽

Randomized Controlled ◽

First Choice ◽

Histological Remission

Abstract Topical corticosteroids are the foundation of pharmacologic treatment for eosinophilic oesophagitis (EoE) and administered mainly as nebulized swallowed fluticasone or budesonide viscous solution (BVS). Recently, a budesonide orodispersible tablet (BOT) has been approved for the treatment of EoE. The ideal formulation of topical corticosteroid delivery is unclear. Therefore, we aimed to compare the efficacy of BOT with other topical corticosteroid formulations for achieving histological remission in adult patients with EoE in a network meta-analysis (NMA). Methods A systematic literature review was performed using Medline and EMBASE from 1990 to July 2019. Eligible studies evaluated adult patients with a diagnosis of EoE treated with a topical corticosteroid in a randomized controlled trial. The outcome of interest was the proportion of patients achieving induction of histological remission (peak esophageal eosinophil count <5 eosinophils/high-power field). Direct comparisons were performed using the Mantel–Haenszel method and an NMA was performed using a fixed effect Bayesian framework with Markov Chain Monte Carlo simulations. Heterogeneity between studies was analyzed using the Cochrane Q test and consistency was verified. Results The search yielded 321 references and 6 (447 patients) were included in the quantitative summary. In the NMA, all formulations of topical corticosteroids were associated with greater histological remission rates than placebo. BOT was associated with a significantly higher rate of histological remission compared to BVS (odds ratio [OR] = 4.9; 95% credible interval [CrI] = 1.4,19.1), fluticasone (OR = 7.4; 95%CrI = 1.7,34.5), nebulized swallowed budesonide (NSB) (OR = 25.0; 95%CrI = 2.9,247.2) and placebo (OR = 387.6; 95%CrI = 97.5,2275.6). Similar trends were shown in direct comparisons. Analysis of the ranking of treatment options based on probability of effectiveness found BOT to be most probable followed by BVS, fluticasone, NSB, and placebo, consecutively. Conclusion This NMA of randomized controlled trials suggests that BOT is significantly more likely to achieve histological remission in adult patients with EoE compared to BVS, fluticasone, and NSB. We hypothesize that the superiority of BOT is related to increased contact time and targeting all inflammatory sites in the oesophagus, in contrast to other formulations. This NMA suggest that BOT is the first choice therapy amongst topical corticosteroids for the management of EoE.

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Meta-analysis of Trials Comparing β-Blockers, Calcium Antagonists, and Nitrates for Stable Angina

JAMA ◽

10.1001/jama.281.20.1927 ◽

1999 ◽

Vol 281 (20) ◽

pp. 1927 ◽

Cited By ~ 230

Author(s):

Paul A. Heidenreich

Keyword(s):

Stable Angina ◽

Calcium Antagonists ◽

Meta Analysis ◽

Β Blockers

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Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis

Journal of Neurosurgery ◽

10.3171/2011.7.jns102142 ◽

2012 ◽

Vol 116 (1) ◽

pp. 210-221 ◽

Cited By ~ 106

Author(s):

Martin M. Mortazavi ◽

Andrew K. Romeo ◽

Aman Deep ◽

Christoph J. Griessenauer ◽

Mohammadali M. Shoja ◽

...

Keyword(s):

Intracranial Pressure ◽

Hypertonic Saline ◽

Observational Studies ◽

Meta Analysis ◽

Review Of The Literature ◽

Effective Agent ◽

Randomized Controlled ◽

Retrospective Comparison ◽

First Choice ◽

Pubmed Search

Object Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction. Methods A PubMed search was performed to locate all papers pertaining to HTS use. This search was then narrowed to locate only those clinical studies relating to the use of HTS for ICP reduction. Results A total of 36 articles were selected for review. Ten were prospective randomized controlled trials (RCTs), 1 was prospective and nonrandomized, 15 were prospective observational trials, and 10 were retrospective trials. The authors did not distinguish between retrospective observational studies and retrospective comparison trials. Prospective studies were considered observational if the effects of a treatment were evaluated over time but not compared with another treatment. Conclusions The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.

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