Comparative Efficacy of Antihypertensive Agents in Flow-Mediated Vasodilation of Patients with Hypertension: Network Meta-Analysis of Randomized Controlled Trial

IF 1.9 4区医学 Q3 PERIPHERAL VASCULAR DISEASE

International Journal of Hypertension Pub Date : 2022-04-30 DOI:10.1155/2022/2432567

Hong Ding, Shu Liu, Kexin Zhao, J. Pu, Yanpi Xie, Xiao-Wei Zhang

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引用次数: 5

Abstract

Hypertension induces both structural and functional changes in blood vessels, thereby increasing endothelial dysfunction, which in turn, contributes to an increase in blood pressure. A popular and widely used noninvasive tool, flow-mediated dilation (FMD), is used to examine peripheral artery endothelium-dependent dilation. This study aimed to compare the efficacies of different classes of antihypertensive agents based on their effects on FMD. PubMed, Embase, and Cochrane Library were queried till November 1, 2020. Comparative studies on the efficacies of two or more antihypertensive agents or placebos for hypertensive patients were included. The outcomes were variations in mean systolic and diastolic blood pressure. Two reviewers independently reviewed and filtered the literature and extracted the data; the Cochrane “risk of bias” method was used to evaluate the methodological quality of the randomized controlled trials. A network meta-analysis was performed using Stata 15.0 software with a total of 49 studies. Subgroup analysis based on age and duration of treatments was performed. As compared to the placebo group, patients receiving the antihypertensive drugs exhibited significantly enhanced FMD (ARB + CCB: 4.01%, 95% CI, 0.92–7.11%, p < 0.001; ACEI + ARB: 2.81%, 95% CI, 1.19–4.43%, p < 0.001; ACEI: 2.55%, 95% CI, 1.34–3.77%, p < 0.001; ARB: 2.22%, 95% CI, 1.05–3.38%, p < 0.001; β-blocker: 2.23%, 95% CI, 0.93–3.52%, p < 0.001). In the SUCRA curve for network meta-analysis, the combination of CCB and ARB was found to be the most effective in increasing FMD (SUCRA = 89.0%), followed by ACEI monotherapy (SUCRA = 74.2%). ARB combined with CCB was superior in improving the endothelial function measured as the FMD; ACEI monotherapy was the most effective treatment among the antihypertension medications. There were no significant differences between antihypertensive drug-based monotherapies.

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降压药对高血压患者血流介导的血管舒张的比较疗效:随机对照试验的网络meta分析

高血压会引起血管结构和功能的变化，从而增加内皮功能障碍，进而导致血压升高。一种流行且广泛使用的非侵入性工具，流介导的扩张（FMD），用于检查外周动脉内皮依赖性扩张。本研究旨在根据不同类别降压药对FMD的影响来比较其疗效。PubMed、Embase和Cochrane Library的查询截止到2020年11月1日。包括两种或两种以上降压药或安慰剂对高血压患者疗效的比较研究。结果是平均收缩压和舒张压的变化。两名评审员对文献进行了独立评审和筛选，并提取了数据；采用Cochrane“偏倚风险”方法评估随机对照试验的方法学质量。使用Stata 15.0软件对总共49项研究进行了网络荟萃分析。根据年龄和治疗持续时间进行亚组分析。与安慰剂组相比，接受降压药物治疗的患者FMD（ARB + CCB：4.01%，95%CI，0.92–7.11%，p<0.001；ACEI + ARB:2.81%，95%CI，1.19–4.43%，p<0.001；ACEI:2.55%，95%CI，1.34–3.77%，p<0.001；ARB:2.22%，95%CI，1.05–3.38%，p<0.001；β-阻滞剂：2.23%，95%可信区间，0.93–3.52%，p<0.001）。在用于网络荟萃分析的SUCRA曲线中，CCB和ARB的组合被发现在增加FMD方面最有效（SUCRA = 89.0%），然后是ACEI单药治疗（SUCRA = 74.2%）。ARB联合CCB在改善FMD测量的内皮功能方面是优越的；ACEI单药治疗是抗高血压药物中最有效的治疗方法。基于降压药物的单一疗法之间没有显著差异。

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来源期刊

International Journal of Hypertension Medicine-Internal Medicine

CiteScore

4.00

自引率

5.30%

发文量

期刊介绍： International Journal of Hypertension is a peer-reviewed, Open Access journal that provides a forum for clinicians and basic scientists interested in blood pressure regulation and pathophysiology, as well as treatment and prevention of hypertension. The journal publishes original research articles, review articles, and clinical studies on the etiology and risk factors of hypertension, with a special focus on vascular biology, epidemiology, pediatric hypertension, and hypertensive nephropathy.