What is the clinical evidence from this study?

Study design: Meta-Analysis. Intervention: Antihypertensive agents vs. Peripheral systolic blood pressure (pSBP). Primary outcome: Difference in reduction between peripheral and central systolic blood pressure (WMD 2.52 mm Hg, 95% CI 1.35 to 3.69).

What does this research mean for the field?

Antihypertensive agents reduce peripheral systolic blood pressure more than central systolic blood pressure, with beta-blockers being the least beneficial class for reducing central systolic blood pressure and augmentation index. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 19, 2015Open Access

Impact of Antihypertensive Agents on Central Systolic Blood Pressure and Augmentation Index: A Meta-Analysis

Key Result

Antihypertensive agents reduced peripheral systolic blood pressure more than central systolic blood pressure (WMD 2.52 mm Hg; 95% CI 1.35-3.69), with beta-blockers being the least beneficial.

Study Design

Type

Meta-Analysis (n=4,381)

Structured PICO

Do antihypertensive agents differentially reduce central systolic blood pressure and augmentation index compared to peripheral systolic blood pressure?

Population

4,381 unique subjects (from 52 studies) for central systolic blood pressure (cSBP) analysis and 3,716 unique subjects (from 58 studies) for augmentation index (AI) analysis

Intervention

Antihypertensive agents as a class (including beta-blockers, alpha-blockers, ACE inhibitors, ARBs, calcium channel blockers, diuretics, RAAS inhibitors, nicorandil, and moxonidine)

Comparator

Baseline values (for AI) and peripheral systolic blood pressure (for cSBP)

Outcome

Change in central systolic blood pressure (cSBP) and augmentation index (AI)surrogate

Beta-blockers are less effective than other antihypertensive classes at reducing central systolic blood pressure and augmentation index, which may explain differences in their impact on cardiovascular outcomes.

Main Result

Effect estimate: WMD 2.52 mm Hg (95% CI 1.35 to 3.69)

Abstract

BACKGROUND: New evidence suggests that central systolic blood pressure (cSBP) and augmentation index (AI) are superior predictors of adverse cardiovascular outcomes compared to peripheral systolic BP (pSBP). We performed a meta-analysis assessing the impact of antihypertensives on cSBP and AI. METHODS: PubMed, Cochrane Library, and CINAHL were searched until September 2014 to identify eligible articles. A DerSimonian and Laird random-effects model was used to calculate the weighted mean difference (WMD) and its 95% confidence interval (CI). Fifty-two and 58 studies incorporating 4,381 and 3,716 unique subjects were included for cSBP and AI analysis, respectively. RESULTS: Overall, antihypertensives reduced pSBP more than cSBP (WMD 2.52 mm Hg, 95% CI 1.35 to 3.69; I (2) = 21.9%). β-Blockers (BBs) posed a significantly greater reduction in pSBP as compared to cSBP (WMD 5.19 mm Hg, 95% CI 3.21 to 7.18). α-Blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, renin-angiotensin aldosterone system inhibitors and nicorandil reduced cSBP and pSBP in a similar manner. The overall reduction in AI from baseline was 3.09% (95% CI 2.28 to 3.90; I (2) = 84.5%). A significant reduction in AI was seen with angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, renin-angiotensin aldosterone system inhibitors, BBs, α-blockers (ABs), nicorandil, and moxonidine reduced AI nonsignificantly. CONCLUSIONS: BBs are not as beneficial as the other antihypertensives in reducing cSBP and AI.