Background
Evidence on the long-term clinical benefits of individual members of angiotensin II
receptor blockers is limited given the lack of head-to-head studies. We conducted
a network meta-analysis to determine the comparative efficacy of different members
within this drug class with respect to outcomes of (i) blood pressure reduction (at
24 and 52 weeks) and (ii) prevention of cardiovascular disease (>104 weeks).
Methods
A systematic literature review was conducted – Protocol registration: (PROSPERO –
CRD42014007067) – to identify relevant literature from the following databases: Cochrane
Library, PubMed, Medline and EMBASE; searched from inception to July 2016. Randomised
controlled trials (RCTs) were included if they reported long-term effectiveness relating
to blood pressure, mortality, myocardial infarction or stroke. Eligible studies included
those with placebo or specific active-treatment comparators (either another angiotensin
II receptor blockers or hydrochlorothiazide). A Bayesian random-effects network model
was used to combine direct within-trial comparisons between treatment groups with
indirect evidence from other trials.
Results
Thirty-six studies were identified, representing 28 unique trials. Blood pressure
reduction, based on 12 studies (n = 807) with fixed dosing regimen, was found to be similar amongst members of the angiotensin
receptor blocker drug class at both 24 and 52 weeks. A network meta-analysis of five
studies (n = 16,716) with a treat-to-target approach found that prevention of all-cause mortality,
stroke and myocardial infarction was similar across the angiotensin-receptor blockers
therapies initiated.
Conclusions
Current evidence is insufficient to show differences in any members within the angiotensin
II receptor blocker drug class with respect to blood pressuring lowering effects or
a reduction in cardiovascular diseases.
Keywords
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Article info
Publication history
Published online: July 14, 2017
Accepted:
June 23,
2017
Received in revised form:
May 24,
2017
Received:
January 21,
2017
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
