Key result
Angiotensin inhibitors match conventional therapy for BP control but cut adverse events by ~34%.
Why the study?
No conclusive high-level evidence from meta-analyses had addressed the comparative efficacy and safety of angiotensin-based regimens versus conventional therapy for isolated systolic hypertension.
Does angiotensin-based pharmacotherapy improve blood pressure reduction, clinical outcomes, or safety compared to conventional therapy with diuretics or CCBs in adults with isolated systolic hypertension?
Meta-Analysis (n=6,296)
Does angiotensin-based pharmacotherapy improve blood pressure reduction, clinical outcomes, or safety compared to conventional therapy with diuretics or CCBs in adults with isolated systolic hypertension?
Mean Difference: 0.09 (95% CI -1.02–1.21)
p-value: p=0.87
Angiotensin inhibitors are as effective as thiazides or CCBs in lowering blood pressure for isolated systolic hypertension but offer a superior safety profile.
Supports angiotensin inhibitors for better safety in isolated systolic hypertension; extends meta-analytic evidence favoring their use over diuretics or CCBs.
The pathophysiology of ISH involves reduced elasticity and amenability of arteries resulting from age and from the atherosclerosis-linked accumulation of calcium and collagen and the degradation of elastin.Stiffened arteries increase the rate of returned AbstractThe angiotensin (AT) system is highly implicated in the pathophysiology of isolated systolic hypertension (ISH).Consequently, this meta-analysis was designed to quantitatively review the efficacy and safety of angiotensin (AT)-based regimens in comparison with conventional thiazide diuretics or calcium channel blockers (CCBs) for the management of ISH.MED-LINE and CENTRAL were searched for relevant randomized controlled trials (RCTs).The outcomes assessed were blood pressure (BP) reduction, mortality, myocardial infarction (MI), stroke, and adverse events (AEs).Statistical analysis was carried out as recommended by the Cochrane Collaboration using data weighted mean difference (WMD) and relative risk (RR).Fourteen studies involving 6296 patients met the selection criteria for inclusion in this meta-analysis.There was no beneficial fall in systolic BP using AT inhibitors versus diuretics or CCBs (WMD = 0.09, 95% confidence interval (CI) -1.02 -1.21, P = 0.87).In addition, AT inhibitors did not adversely lower the diastolic BP compared to diuretics or CCBs.There was also no significant reduction by the AT inhibitors in the primary efficacy outcomes including mortality, MI and stroke.Interestingly, AT inhibition demonstrated a significantly lower incidence of AEs better than conventional therapy (RR = 0.66, 95% CI 0.5 -0.87, P = 0.003).Therefore, there is strong evidence to conclude the comparative effectiveness of AT inhibition versus thiazide-induced diuresis or calcium antagonism regarding efficacy outcomes.There is also sufficient evidence to recommend AT inhibition as initial choice with regard to its safety for the management of ISH in adults.
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AI et al. (2016) conducted a meta-analysis in Isolated Systolic Hypertension (n=6,296). Angiotensin inhibitors (ACEIs or ARBs) vs. Thiazide diuretics or calcium channel blockers (CCBs) was evaluated on Systolic blood pressure (sBP) reduction (WMD 0.09, 95% CI -1.02 - 1.21, p=0.87). Angiotensin inhibitors did not further reduce systolic blood pressure versus conventional therapy (WMD 0.09, p=0.87) but significantly lowered adverse events (RR 0.66, p=0.003).
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