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dc.contributor.authorFretheim, Atle
dc.contributor.authorOdgaard-Jensen, Jan
dc.contributor.authorBrørs, Odd
dc.contributor.authorMadsen, Steinar
dc.contributor.authorNjølstad, Inger
dc.contributor.authorNorheim, Ole Frithjof
dc.contributor.authorSvilaas, Arne B
dc.contributor.authorThürmer, Hanne
dc.contributor.authorFlottorp, Signe
dc.date.accessioned2012-09-06T12:58:02Z
dc.date.available2012-09-06T12:58:02Z
dc.date.issued2012
dc.description.abstractWe conducted a systematic review of evidence from randomized controlled trials to answer the following research question: What are the relative effects of different classes of antihypertensive drugs in reducing the incidence of cardiovascular disease outcomes for healthy people at risk of cardiovascular disease? We searched MEDLINE, EMBASE, AMED (up to February 2011) and CENTRAL (up to May 2009), and reference lists in recent systematic reviews. Titles and abstracts were assessed for relevance and those potentially fulfilling our inclusion criteria were then assessed in full text. Two reviewers made independent assessments at each step. We selected the following main outcomes: total mortality, myocardial infarction and stroke. We also report on angina, heart failure and incidence of diabetes. We conducted a multiple treatments meta-analysis using random-effects models. We assessed the quality of the evidence using the GRADE-instrument. We included 25 trials. Overall, the results were mixed, with few significant dif-ferences, and with no drug-class standing out as superior across multiple outcomes. The only significant finding for total mortality based on moderate to high quality evidence was that beta-blockers (atenolol) were inferior to angiotensin receptor blockers (ARB) (relative risk (RR) 1.14; 95% credibility interval (CrI) 1.02 to 1.28). Angiotensin converting enzyme (ACE)-inhibitors came out inferior to calcium-channel blockers (CCB) regarding stroke-risk (RR 1.19; 1.03 to 1.38), but superior regarding risk of heart failure (RR 0.82; 0.69 to 0.94), both based on moderate quality evidence. Diuretics reduced the risk of myocardial infarction compared to beta-blockers (RR 0.82; 0.68 to 0.98), and lowered the risk of heart failure compared to CCB (RR 0.73; 0.62 to 0.84), beta-blockers (RR 0.73; 0.54 to 0.96), and alpha-blockers (RR 0.51; 0.40 to 0.64). The risk of diabetes increased with diuretics compared to ACE-inhibitors (RR 1.43; 1.12 to 1.83) and CCB (RR 1.27; 1.05 to 1.57). Based on the available evidence, there seems to be little or no difference between commonly used blood pressure lowering medications for primary prevention of cardiovascular disease. Beta-blockers (atenolol) and alpha-blockers may not be first-choice drugs as they were the only drug-classes that were not significantly superior to any other, for any outcomes.en
dc.identifier.citationBMC Medicine (2012), 10:33en
dc.identifier.cristinIDFRIDAID 920208
dc.identifier.doidoi: 10.1186/1741-7015-10-33
dc.identifier.issn1741-7015
dc.identifier.urihttps://hdl.handle.net/10037/4413
dc.identifier.urnURN:NBN:no-uit_munin_4129
dc.language.isoengen
dc.publisherBioMed Centralen
dc.rights.accessRightsopenAccess
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771en
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771en
dc.titleComparative effectiveness of antihypertensive medication of primary prevention of cardiovascular disease : systematic review and multiple treatments meta-analysisen
dc.typeJournal articleen
dc.typeTidsskriftartikkelen
dc.typePeer revieweden


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