Key result
Angiotensin converting enzyme inhibitors and AT1R blockers improved overall quality of life compared with placebo or other antihypertensives (SMD 0.11; 95% CI 0.08-0.14; p<0.0001).
Why the study?
Do ACE inhibitors or AT1R blockers improve the mental health domain of quality of life in adults without major physical symptoms?
Meta-Analysis
Do ACE inhibitors or AT1R blockers improve the mental health domain of quality of life in adults without major physical symptoms?
Effect estimate: SMD 0.11 (95% CI 0.08-0.14)
p-value: p=< 0.0001
Blockade of the angiotensin system with ACE inhibitors or ARBs is associated with small but significant improvements in mental health domains of quality of life in hypertensive adults.
ACE inhibitors or ARBs may modestly improve mental health quality of life in hypertensive adults; extends their benefits beyond blood pressure reduction.
OBJECTIVE: It is unclear whether blockade of the angiotensin system has effects on mental health. Our objective was to determine the impact of angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor (AT1R) blockers on mental health domain of quality of life. STUDY DESIGN: Meta-analysis of published literature. DATA SOURCES: PubMed and clinicaltrials.gov databases. The last search was conducted in January 2017. STUDY SELECTION: Randomized controlled trials comparing any angiotensin converting enzyme inhibitor or AT1R blocker versus placebo or non-angiotensin converting enzyme inhibitor or non-AT1R blocker were selected. Study participants were adults without any major physical symptoms. We adhered to meta-analysis reporting methods as per PRISMA and the Cochrane Collaboration. DATA SYNTHESIS: Eleven studies were included in the analysis. When compared with placebo or other antihypertensive medications, AT1R blockers and angiotensin converting enzyme inhibitors were associated with improved overall quality of life (standard mean difference = 0.11, 95% confidence interval = [0.08, 0.14], p < 0.0001), positive wellbeing (standard mean difference = 0.11, 95% confidence interval = [0.05, 0.17], p < 0.0001), mental (standard mean difference = 0.15, 95% confidence interval = [0.06, 0.25], p < 0.0001), and anxiety (standard mean difference = 0.08, 95% confidence interval = [0.01, 0.16], p < 0.0001) domains of QoL. No significant difference was found for the depression domain (standard mean difference = 0.05, 95% confidence interval = [0.02, 0.12], p = 0.15). CONCLUSIONS: Use of angiotensin blockers and inhibitors for the treatment of hypertension in otherwise healthy adults is associated with improved mental health domains of quality of life. Mental health quality of life was a secondary outcome in the included studies. Research specifically designed to analyse the usefulness of drugs that block the angiotensin system is necessary to properly evaluate this novel psychiatric target.
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Brownstein et al. (2017) conducted a meta-analysis in Hypertension. Angiotensin converting enzyme inhibitors and AT1R blockers vs. Placebo or non-angiotensin converting enzyme inhibitor or non-AT1R blocker was evaluated on Overall quality of life (SMD 0.11, 95% CI 0.08-0.14, p=< 0.0001). Angiotensin converting enzyme inhibitors and AT1R blockers improved overall quality of life compared with placebo or other antihypertensives (SMD 0.11; 95% CI 0.08-0.14; p<0.0001).
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