Abstract
Objective: To analyze the combination in randomized clinical trials (RCTs) that described the second drug of choice for antihypertensive treatment (angiotensin-converting enzyme inhibitors – ACEIs or angiotensin receptor blockers - ARBs), by intention to treat. Design and method: Systematic review and metanalysis of the RCTs. A database search between 1966 and December 2018 identified eligible RCTs (PubMed, Embase, Scopus, Web of Science/ Web of Knowledge). Risk ratios and their 95% confidence intervals of four outcomes were estimated by a random-effects model. The heterogeneity index of the studies was calculated through I2 test. The risk of bias was assessed using the Risk of Bias (RoB1), from Cochrane Collaboration. All data were analyzed by two independent evaluators (E.B. and B.E.) and the discrepancies were solved by a third evaluator (W.S.B). Results: 46 eligible RCTs were identified. The ACE treatment in combination reduced cardiovascular mortality (−15%), total mortality, stroke and AMI (p < 0.001). The methodological quality of the included studies pointed to an unclear risk of bias. Conclusions: The ACE inhibitors, in combination, present a reduction in cardiovascular mortality, while the ARBs in combination, do not demonstrate this reduction.
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