Faculty Opinions recommendation of Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials.

ObjectiveThere is currently no medical treatment proven to limit abdominal aortic aneurysm (AAA) progression. The aim of this systematic review and meta-analysis was to pool data from previous randomised controlled trials assessing the efficacy of blood pressure-lowering and antibiotic medications in limiting AAA growth and AAA-related events, that is, rupture or repair.MethodsA systematic literature search was performed to identify randomised controlled trials that examined the efficacy of blood pressure-lowering medications or antibiotics in reducing AAA growth and AAA-related events. AAA growth (mm/year) was measured by ultrasound or computed tomography imaging. Meta-analyses were performed using random effects models. A subanalysis was conducted including trials that investigated tetracycline or macrolide antibiotics.ResultsTen randomised controlled trials including 2045 participants with an asymptomatic AAA were included. Follow-up was between 18 and 63 months. Neither blood pressure-lowering medications (mean growth±SD 2.0±2.4 vs 2.3±2.7 mm/year; standardised mean difference (SMD) −0.07, 95% CI −0.19 to 0.06; p=0.288) or antibiotics (mean growth±SD 2.6±2.1 vs 2.6±2.5 mm/year; SMD −0.11, 95% CI −0.38 to 0.16; p=0.418) reduced AAA growth or AAA-related events (blood pressure-lowering medications: 92 vs 95 events; risk ratio (RR) 0.86, 95% CI 0.66 to 1.11; p=0.244; and antibiotics: 69 vs 73 events; RR 0.93, 95% CI 0.69 to 1.25; p=0.614). The subanalysis of antibiotics showed similar results.ConclusionsThis meta-analysis suggests that neither blood pressure-lowering medications or antibiotics limit growth or clinically relevant events in people with AAAs.

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Effect of blood pressure lowering medications on leg ischemia in peripheral artery disease patients: A meta-analysis of randomised controlled trials

PLoS ONE ◽

10.1371/journal.pone.0178713 ◽

2017 ◽

Vol 12 (6) ◽

pp. e0178713 ◽

Cited By ~ 6

Author(s):

Diana Thomas Manapurathe ◽

Smriti Murali Krishna ◽

Brittany Dewdney ◽

Joseph Vaughan Moxon ◽

Erik Biros ◽

...

Keyword(s):

Blood Pressure ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Blood Pressure Lowering ◽

Peripheral Artery ◽

Pressure Lowering ◽

Artery Disease ◽

Randomised Controlled ◽

Leg Ischemia

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Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials

Yearbook of Cardiology ◽

10.1016/s0145-4145(10)79925-1 ◽

2010 ◽

Vol 2010 ◽

pp. 10-12

Author(s):

W.J. Elliott

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Cardiovascular Events ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomised Controlled

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Synergistic effects of blood pressure-lowering drugs and statins: systematic review and meta-analysis

BMJ evidence-based medicine ◽

10.1136/bmjebm-2017-110888 ◽

2018 ◽

Vol 23 (2) ◽

pp. 64-69 ◽

Cited By ~ 6

Author(s):

Johan Sundström ◽

Gullik Gulliksson ◽

Marcus Wirén

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Fixed Combination ◽

Synergistic Effects ◽

Meta Analysis ◽

Treatment Decision ◽

Blood Pressure Lowering ◽

Decision Strategies ◽

Major Cardiovascular Events ◽

Pressure Lowering

BackgroundSynergistic effects of blood pressure-lowering drugs and statins are unknown, but are key to risk-based treatment decision strategies and fixed-combination polypills.ObjectiveWe conducted a systematic literature review and meta-analysis to test the hypothesis that the combined relative effects of blood pressure-lowering drugs and statins on cardiovascular outcomes are multiplicative.Study selectionTwo persons independently searched five data sources and hand-searched reference lists from earliest available to December 2017. We included factorial trials with at least two randomised interventions including one statin versus placebo factor and one blood pressure-lowering drug/more intense blood pressure-lowering regimen versus placebo/less intense regimen factor, and reported cardiovascular events or mortality as outcomes. We tested interactions as departures from additivity or multiplicativity using mixed-effects logistic regression models.FindingsSeven out of 1017 screened studies fulfilled the selection criteria, contributing a total of 27 020 patients with 857 major cardiovascular events and 725 deaths. The relative risk reduction of major cardiovascular events with active/more intense blood pressure-lowering regimen was not materially different in subgroups randomised to statins (risk ratio 0.81, 95% CI 0.66 to 1.00) or placebo (0.94, 0.79 to 1.11). Likewise, statin effects were not substantially different in subgroups randomised to active/more intense blood pressure-lowering regimen (0.69, 0.57 to 0.85) or placebo/less intense regimen (0.80, 0.67 to 0.96). No departures from either additivity or multiplicativity were observed. Heterogeneity was low.ConclusionsThe combined relative effects of blood pressure-lowering drugs and statins on cardiovascular events were multiplicative. This supports risk-based treatment decision strategies and fixed-combination polypills.

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Homocysteine-lowering therapy does not lead to reduction in cardiovascular outcomes in chronic kidney disease patients: a meta-analysis of randomised, controlled trials

British Journal Of Nutrition ◽

10.1017/s0007114511007033 ◽

2012 ◽

Vol 108 (3) ◽

pp. 400-407 ◽

Cited By ~ 21

Author(s):

Yu Pan ◽

Li Li Guo ◽

Ling Ling Cai ◽

Xiao Juan Zhu ◽

Jin Lian Shu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cardiovascular Events ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Controlled Clinical Trials ◽

Lowering Therapy ◽

All Cause Mortality ◽

Randomised Controlled ◽

Stratified Analysis

The efficacy of homocysteine (Hcy)-lowering therapy in reducing the risk of CVD among patients with chronic kidney disease (CKD) remains controversial. We performed a meta-analysis to determine whether pooling the data from the few small randomised, controlled trials that address this topic would improve the statistical power of the analysis and resolve some of the inconsistencies in the results. Randomised, controlled clinical trials (RCT) were identified from MEDLINE, EMBASE, www.clinicaltrials.gov, the Cochrane Controlled Clinical Trials Register Database and Nephrology Filters. Independent extraction of articles was performed using predefined data fields. The primary outcome was relative risk (RR) of CVD, CHD, stroke and all-cause mortality for the pooled trials. A stratified analysis was planned, assessing the RR for cardiovascular events between the patients on and not on dialysis. Overall, ten studies met the inclusion criteria. The estimated RR were not significantly different for any outcomes, including CHD (RR 1·00, 95 % CI 0·75, 1·31, P = 0·97), CVD (RR 0·94, 95 % CI 0·84, 1·05, P = 0·30), stroke (RR 0·83, 95 % CI 0·57, 1·19, P = 0·31) and all-cause mortality (RR 1·00, 95 % CI 0·92, 1·09, P = 0·98). In the stratified analysis, the estimated RR were not significantly different for cardiovascular events regardless of dialysis or in combination with vitamin B therapy or the degree of reduction in Hcy levels. Our meta-analysis of RCT supports the conclusion that Hcy-lowering therapy was not associated with a significant decrease in the risk for CVD events, stroke and all-cause mortality among patients with CKD.

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