title: Treatment efficacy of anti-hypertensive drugs in monotherapy or combination: ATOM systematic review and meta-analysis of randomized clinical trials according to PRISMA statement.
abstract: BACKGROUND
  The relative efficacy of antihypertensive drugs/combinations is not well known. Identifying the most effective ones and the patients' characteristics associated with best performance of the drugs will improve management of hypertensive patients.
  
  
  OBJECTIVE
  To assess the blood pressure (BP) reduction attributed to antihypertensive drugs and identify characteristics associated with BP decrease.
  
  
  METHODS
  MEDLINE, Cochrane Central Register of Controlled Trials from inception through July 2012 and selected papers.
  
  
  METHODS
  Double-blind, randomized clinical trials whose main result was the reduction in BP by antihypertensive treatment, with study population ≥50 or ≥25 if the study was a crossover, follow-up of at least 8 weeks, and available required data.
  
  
  METHODS
  Study data were independently extracted by multiple observers and introduced in an electronic database. Inconsistencies were resolved by discussion and referral back to the original articles. Meta-analysis was performed according to PRISMA statement and using a Bayesian framework.
  
  
  METHODS
  Mean decrease in systolic (SBP) and diastolic blood pressure (DBP) achieved by each drug or combination.
  
  
  RESULTS
  Two hundred eight trials including 94,305 patients were identified. In monotherapy, most drugs achieved 10 to 15 mm Hg SBP and 8 to 10 mm Hg DBP decreases.Olmesartan/amlodipine, olmesartan/hydrochlorothiazide, felodipine/metoprolol, and valsartan/hydrochlorothiazide were the combinations leading to the greatest mean SBP reductions (>20 mm Hg). Female sex and body mass index >25 kg/m were associated with more pronounced SBP and DBP reductions, whereas Afro-American ethnicity was associated with BP reductions smaller than the median. Results were adjusted by study duration, cardiovascular disease, and diabetes mellitus. Still, the estimation was performed using the mean administered doses, which do not exactly match those of the available drug formats.
  
  
  CONCLUSIONS
  Data corresponded to those obtained in each of the included trials; the analysis of the combinations was limited to the most recent ones; estimations were performed using the mean administered doses.
  
  
  CONCLUSIONS
  Certain drug combinations achieve BP reductions ranging from 20 to 25/10 to 15 mm Hg. Sex, ethnicity, and obesity are associated with antihypertensive response. This information can contribute to better selection of the antihypertensive drug, depending on the magnitude of pretreatment BP elevation. Guidelines should be revised.
authors.affiliation: Hospital de Santa Caterina, Girona Hospital Mutua Terrassa, University of Barcelona-Terrassa (Barcelona) Research Group on Statistics, Econometrics and Health (GRECS), University of Girona CIBER of Epidemiology and Public Health (CIBERESP) Department of Medical Sciences, University of Girona CAP Can Gibert del Plà, Girona Research Unit, USR Girona, IdIAP Gol i Gorina, ICS, Spain.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Paz
authors.forename: Alejandro
authors.initials: A
authors.lastname: de-La-Sierra
authors.forename: Marc
authors.initials: M
authors.lastname: Sáez
authors.forename: María Antonia
authors.initials: MA
authors.lastname: Barceló
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Rodríguez
authors.forename: Sonia
authors.initials: S
authors.lastname: Castro
authors.forename: Cristina
authors.initials: C
authors.lastname: Lagarón
authors.forename: Josep M
authors.initials: JM
authors.lastname: Garrido
authors.forename: Pilar
authors.initials: P
authors.lastname: Vera
authors.forename: Gabriel
authors.initials: G
authors.lastname: Coll-de-Tuero
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D009765:Obesity / Q000150:complications; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors
chemical_list: D000959:Antihypertensive Agents