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A Meta-Analytical Approach to the Efficacy of Antihypertensive Drugs in Reducing Blood Pressure

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Abstract

Introduction: Hypertension constitutes a veritable public health issue. Several classes of drugs are available for the treatment of hypertension. The objective of this meta-analytical approach was to assess the efficacy of antihypertensive drugs most commonly used in France in reducing clinical SBP and DBP.

Methods: The antihypertensive drugs selected were hydrochlorothiazide, indapamide sustained release (SR), furosemide and spironolactone for diuretics; amlodipine and lercanidipine for calcium channel antagonists; atenolol for β-adrenoceptor antagonists (β-blockers); enalapril and ramipril for ACE inhibitors; and candesartan cilexetil, irbesartan, losartan, and valsartan for angiotensin II receptor antagonists. The trials selected were published between 1973 and 2004, evaluated monotherapy with trial drugs as fixed-dosage or with dosage increase, and assessed blood pressure reduction between 2 and 3 months. The analysis method used was based on the calculation of the sum weighted for the trial size.

Results: A total of 72 trials (comprising 9094 patients) were selected and analyzed. No trial evaluating furosemide or spironolactone satisfied the inclusion criteria for this analysis. For SBP, the reduction was more marked with diuretics, calcium channel antagonists, and ACE inhibitors. Of all the drugs studied, indapamide SR gave the greatest SBP reduction (−22.2mm Hg). Evaluated therapeutic classes had a similar magnitude of effect on DBP, i. e. reduction between −11.4mm Hg with β-adrenoceptor antagonists and −10.3mm Hg with angiotensin II type 1 receptor antagonists.

Conclusion: Indapamide SR 1.5mg appeared to be the most effective drug for a significant reduction in SBP within 2–3 months, which is an essential element in optimizing cardiovascular prevention among hypertensive patients. The clinical application of these results should take into consideration all the limitations discussed in this analysis.

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Notes

  1. Valsartan 160 mg/day dosage was not approved for clinical use in France when this analysis was performed.

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Acknowledgments

This project was supported by a grant from Eutherapie (Les Laboratoires Servier). The study was conducted, analysed, and interpreted by the investigators independently of all sponsors.

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  1. Cardiology and Hypertension Unit, Grenoble University Hospital, Grenoble, France

    Jean-Philippe Baguet

  2. Department of Public Health — Unit of Research: Health Related Quality of Life, University of Marseille, Marseille, France

    Stephane Robitail, Laurent Boyer, David Debensason &  Pascal Auquier

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  1. Jean-Philippe Baguet
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  2. Stephane Robitail
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  5. Pascal Auquier
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Correspondence to Pascal Auquier.

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Baguet, JP., Robitail, S., Boyer, L. et al. A Meta-Analytical Approach to the Efficacy of Antihypertensive Drugs in Reducing Blood Pressure. Am J Cardiovasc Drugs 5, 131–140 (2005). https://doi.org/10.2165/00129784-200505020-00007

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