Abstract 506: Blood Pressure-lowering Effects Of Anti-hypertensive Drugs And Combinations: Meta-regression Of Published Clinical Trials. The Atom Study

Abstract

Background and aim: The use of antihypertensive drugs should be based on the knowledge of their blood pressure (BP)-lowering effect . Most of the clinical trials only assess such effects by comparing 2 different drugs or treatment strategies. However, the relative effect of major antihypertensive drug classes or the most used compounds inside each class is less known. The aim of the study was to assess the BP-lowering effect of most commonly used drugs or drug combinations, by reviewing data from clinical trials based on drug efficacy. Patients and methods: Clinical trials with at least 50 patients recruited, in which BP reduction was the primary outcome, were obtained from a systematic review of Medline and Cochrane Central Register of Controlled Trials. Studies without clearly established data of doses or baseline or final BP values were excluded. Data were analyzed by Bayesian meta-regression, adjusted by baseline BP, age, gender, ethnicity, and number of patients included. Only those drugs with a minimum number of studies, which allowed the Bayesian meta-regression, were included. Results: 253 studies including 937 treatment arms were reviewed. Total number of patients included was 138,971. Systolic BP reduction with monotherapy did not, generally, overcome 20 mmHg, with bisoprolol (mean -15,6 mmHg, 95% CI: -27,4; -1,7) and olmesartan (-15,3 mmHg, 95% CI -18.2; -11,7) resulting the most efficacious drugs. Diastolic BP was reduced by 10 mmHg; being olmesartan the drug promoting a more pronounced reduction (-11.5 mmHg, 95% CI: -13.5; - 9.4). In studies using antihypertensive combinations, the greatest systolic BP reduction was obtained with olmesartan/amlodipine (-31.6 mmHg, CI: -54.6; -22.6) and valsartan/hydrochlorothiazide (-31.4 mmHg, CI: -39.0; -23.0). Conclusions: This systematic review reflects the expected BP reductions with the use of the most common antihypertensive compounds or combinations. The results may allow the clinician to choose the most appropriate treatment taking into account patients’ BP and the required reduction to reach the goal.