Antihypertensive Treatment and Central Arterial Hemodynamics: A Meta-Analysis of Randomized Controlled Trials

Background: Antihypertensive treatment may have different effects on central arterial hemodynamics. The extent of the difference in effects between various antihypertensive drugs remains undefined.Methods: We conducted a systematic review and meta-analysis of randomized controlled trials that explored the effects of antihypertensive agents on both central and peripheral systolic blood pressure (SBP) and pulse pressure (PP) or central augmentation index, with a special focus on the comparison between newer [renin-angiotensin-aldosterone system (RAS) inhibitors and calcium-channel blockers (CCBs)] and older antihypertensive agents (diuretics and β- and α-blockers).Results: In total, 20 studies (n = 2,498) were included. Compared with diuretics (10 studies), β-blockers (16 studies), or an α-blocker (1 study), RAS inhibitors (21 studies), and CCBs (6 studies) more efficaciously (P < 0.001) reduced both central and peripheral SBP by a weighted mean difference of −5.63 (−6.50 to −4.76 mmHg) and −1.97 mmHg (−2.99 to −0.95 mmHg), respectively. Compared with older agents, the newer agents also more efficaciously (P < 0.001) reduced central PP (−3.27 mmHg; −4.95 to −1.59 mmHg), augmentation index (−6.11%; −7.94 to −4.29) and augmentation (−3.35 mmHg; −5.28 to –1.42 mmHg) but not peripheral PP (p ≥ 0.09). Accordingly, the newer agents reduced central-to-peripheral PP amplification significantly less than the older agents (0.11 mmHg; 0.05 to 0.17 mmHg; P < 0.001).Conclusion: Newer agents, such as RAS inhibitors and CCBs, were significantly more efficacious than older agents in their effects on central hemodynamics.

Download Full-text

Role of Blood Pressure Management in Stroke Prevention: A Systematic Review and Network Meta-Analysis of 93 Randomized Controlled Trials

Journal of Stroke ◽

10.5853/jos.2020.02698 ◽

2021 ◽

Vol 23 (1) ◽

pp. 1-11

Author(s):

Xiao-Ling Zhong ◽

Yi Dong ◽

Wei Xu ◽

Yu-Yuan Huang ◽

Hui-Fu Wang ◽

...

Keyword(s):

Blood Pressure ◽

Randomized Controlled Trials ◽

Stroke Prevention ◽

Meta Analysis ◽

Antihypertensive Agents ◽

Tolerability Profile ◽

Controlled Trials ◽

Converting Enzyme Inhibitors ◽

Randomized Controlled ◽

Pairwise Analysis

Background and Purpose The present study aimed to compare the efficacy and tolerability of different blood pressure (BP)-lowering strategies.Methods Randomized controlled trials that compared various antihypertensive treatments and stroke outcomes were included. Eligible trials were categorized into three scenarios: single or combination antihypertensive agents against placebos; single or combination agents against other agents; and different BP-lowering targets. The primary efficacy outcome was the risk reduction pertaining to strokes. The tolerability outcome was the withdrawal of drugs, owing to drug-related side effects (PROSPERO registration number CRD42018118454 [20/12/2018]).Results The present study included 93 trials (average follow-up duration, 3.3 years). In the pairwise analysis, angiotensin-converting enzyme inhibitors (ACEis) and beta-blockers (BBs) were inferior to calcium channel blockers (CCBs) (odds ratio [OR], 1.123; 95% confidence interval [CI], 1.008 to 1.252) (OR, 1.261; 95% CI, 1.116 to 1.425) for stroke prevention, BB was inferior to angiotensin II receptor blockers (ARB) (OR, 1.361; 95% CI, 1.142 to 1.622), and diuretics were superior to ACEi (OR, 0.871; 95% CI, 0.771 to 0.984). The combination of ACEi+CCB was superior to ACEi+diuretic (OR, 0.892; 95% CI, 0.823 to 0.966). The network meta-analysis confirmed that diuretics were superior to BB (OR, 1.34; 95% CI, 1.11 to 1.58), ACEi+diuretic (OR, 1.47; 95% CI, 1.02 to 2.08), BB+CCB (OR, 2.05; 95% CI, 1.05 to 3.79), and renin inhibitors (OR, 1.87; 95% CI, 1.25 to 2.75) for stroke prevention. Regarding the tolerability profile, the pairwise analysis revealed that ACEi was inferior to CCB and less tolerable, compared to the other treatments.Conclusions Monotherapy using diuretics, CCB, or ARB, and their combinations could be employed as first-line treatments for stroke prevention in terms of efficacy and tolerability.

Download Full-text

Carotid Intima-Media Thickness and Antihypertensive Treatment: A Meta-Analysis of Randomized Controlled Trials

Yearbook of Cardiology ◽

10.1016/s0145-4145(08)70038-8 ◽

2007 ◽

Vol 2007 ◽

pp. 69-71

Author(s):

W.J. Elliott

Keyword(s):

Randomized Controlled Trials ◽

Antihypertensive Treatment ◽

Meta Analysis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Controlled Trials ◽

Randomized Controlled ◽

Media Thickness

Download Full-text

Does zinc with and without iron co-supplementation have effect on motor and mental development of children? A systematic review and meta-analysis

BMC Pediatrics ◽

10.1186/s12887-020-02340-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Firoozeh Sajedi ◽

Soheila Shahshahani ◽

Hesam Ghiasvand ◽

Zahra Mosallanezhad ◽

Shiva Fatollahierad

Keyword(s):

Systematic Review ◽

Child Development ◽

Randomized Controlled Trials ◽

Motor Development ◽

Zinc Supplementation ◽

Meta Analysis ◽

Controlled Trials ◽

Special Focus ◽

Cochrane Central Register ◽

Randomized Controlled

Abstract Background Effects of zinc with and without iron co-supplementation on child development are uncertain therefore the aims of this systematic review were to explore whether supplementation with zinc alone and zinc with iron in children aged 0–5 years old have beneficial or adverse effects on their mental and motor development. Method We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science and Scopus until July 2020 and included randomized controlled trials, which assessed effects of zinc supplementation with and without iron in children less than 5 years old on mental and motor development. Data were pooled by random effects model and the Standardized Mean Differences (SMDs) with 95% confidence interval were estimated. The heterogeneity was assessed by I2. Results Twenty-five studies with 11,559 participants were eligible to be included in this systematic review. Meta-analysis was conducted with eight articles that used Bayley Scales of Infant and Toddler Development II. We concluded that zinc alone and zinc with iron co-supplementation do not have beneficial or adverse effect on child mental and motor development at 6 and 12 months of age with low to moderate quality of the evidence. Furthermore, Zinc supplementation does not have any long term effect on child development in preschool and school age children. Conclusion Most included studies did not show the efficacy of zinc with and without iron co-supplementation on child mental and motor development up to 9 years old age. Further Randomized Controlled Trials (RCTs) need to be taken into considerations the context-based differences between countries with special focus on socio-economic differences.

Download Full-text