dc.contributor.author | Sinnott, S-J | en_US |
dc.contributor.author | Tomlinson, LA | en_US |
dc.contributor.author | Root, AA | en_US |
dc.contributor.author | Mathur, R | en_US |
dc.contributor.author | Mansfield, KE | en_US |
dc.contributor.author | Smeeth, L | en_US |
dc.contributor.author | Douglas, IJ | en_US |
dc.date.accessioned | 2017-05-15T11:44:28Z | |
dc.date.available | 2016-09-29 | en_US |
dc.date.issued | 2017-02 | en_US |
dc.date.submitted | 2017-02-17T12:23:03.781Z | |
dc.identifier.uri | http://qmro.qmul.ac.uk/xmlui/handle/123456789/23099 | |
dc.description.abstract | Aim We assessed the effectiveness of fourth-line mineralocorticoid receptor antagonists in comparison with other fourth-line anti-hypertensive agents in resistant hypertension. Methods and results We systematically searched Medline, EMBASE and the Cochrane library from database inception until January 2016. We included randomised and non-randomised studies that compared mineralocorticoid receptor antagonists with other fourth-line anti-hypertensive agents in patients with resistant hypertension. The outcome was change in systolic blood pressure, measured in the office, at home or by ambulatory blood pressure monitoring. Secondary outcomes were changes in serum potassium and occurrence of hyperkalaemia. We used random effects models and assessed statistical heterogeneity using the I2 test and corresponding 95% confidence intervals. From 2,506 records, 5 studies met our inclusion criteria with 755 included patients. Two studies were randomised and three were non-randomised. Comparative fourth-line agents included bisoprolol, doxazosin, furosemide and additional blockade of the renin angiotensin-aldosterone system. Using data from randomised studies, mineralocorticoid receptor antagonists reduced blood pressure by 7.4 mmHg (95%CI 3.2 - 11.6) more than the active comparator. When limited to non-randomised studies, mineralocorticoid receptor antagonists reduced blood pressure by 11.9 mmHg (95% CI 9.3 - 14.4) more than the active comparator. Conclusion On the basis of this meta-analysis, mineralocorticoid receptor antagonists reduce blood pressure more effectively than other fourth-line agents in resistant hypertension. Effectiveness stratified by ethnicity and comorbidities, in addition to information on clinical outcomes such as myocardial infarction and stroke, now needs to be determined. | en_US |
dc.description.sponsorship | SJS is supported by a Wellcome Trust Sir Henry
Wellcome Fellowship [107340/Z/15/Z]. LS is supported by a
Wellcome Trust Senior Research Fellowship in Clinical
Science (098504/Z/12/Z). LT is supported by a Wellcome
Trust Intermediate Clinical Fellowship (101143/Z/13/Z). AR
is supported by a Medical Research Council Population
Health Scientist fellowship (MR/M014649/1). ID is supported
by an unrestricted grant from GlaxoSmithKline. | en_US |
dc.format.extent | 228 - 238 | en_US |
dc.language | eng | en_US |
dc.relation.ispartof | Eur J Prev Cardiol | en_US |
dc.rights | Sarah-Jo Sinnott, Laurie A Tomlinson, Adrian A Root, Rohini Mathur, Kathryn E Mansfield, Liam Smeeth, Ian J Douglas, Comparative effectiveness of fourth-line anti-hypertensive agents in resistant hypertension: A systematic review and meta-analysis, European Journal of Preventive Cardiology, 24 (3) pp. 228-238. Copyright © 2016 The European Society of Cardiology. Reprinted by permission of SAGE Publications. http://dx.doi.org/10.1177/2047487316675194 | |
dc.subject | Resistant hypertension | en_US |
dc.subject | blood pressure | en_US |
dc.subject | comparative effectiveness research | en_US |
dc.subject | meta-analysis | en_US |
dc.subject | mineralocorticoid receptor antagonists | en_US |
dc.subject | spironolactone | en_US |
dc.subject | Aged | en_US |
dc.subject | Antihypertensive Agents | en_US |
dc.subject | Biomarkers | en_US |
dc.subject | Blood Pressure | en_US |
dc.subject | Chi-Square Distribution | en_US |
dc.subject | Comparative Effectiveness Research | en_US |
dc.subject | Drug Resistance | en_US |
dc.subject | Drug Therapy, Combination | en_US |
dc.subject | Female | en_US |
dc.subject | Humans | en_US |
dc.subject | Hyperkalemia | en_US |
dc.subject | Hypertension | en_US |
dc.subject | Male | en_US |
dc.subject | Middle Aged | en_US |
dc.subject | Mineralocorticoid Receptor Antagonists | en_US |
dc.subject | Potassium | en_US |
dc.subject | Risk Factors | en_US |
dc.subject | Treatment Outcome | en_US |
dc.title | Comparative effectiveness of fourth-line anti-hypertensive agents in resistant hypertension: A systematic review and meta-analysis. | en_US |
dc.type | Article | |
dc.rights.holder | © The European Society of Cardiology 2016 | |
dc.identifier.doi | 10.1177/2047487316675194 | en_US |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/27856806 | en_US |
pubs.issue | 3 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 24 | en_US |