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Review
. 2020 Aug 24;9(1):195.
doi: 10.1186/s13643-020-01457-9.

Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide - which is the better alternative? A meta-analysis

Elena Filipova  1 , Stela Dineva  2 , Katya Uzunova  2 , Velichka Pavlova  2 , Krassimir Kalinov  3 , Toni Vekov  4
Affiliations
Review

Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide - which is the better alternative? A meta-analysis

Elena Filipova et al. Syst Rev. .

Abstract

Background: Hypertension is a disease with significant clinical and socio-economic consequences. The reduction in cardiovascular mortality and morbidity in patients treated for hypertension is directly related to the magnitude of blood pressure reduction. Diuretics have proven useful for the prevention of cardiovascular complications in addition to a long history of safety and efficacy. The main aim for this meta-analysis is to compare the efficacy of the combination of angiotensin receptor blocker (ARB) and chlorthalidone (CTLD) to the combination of ARB and hydrochlorothiazide (HCTZ) in patients with hypertension.

Methods: A comprehensive literature search was conducted through electronic databases PubMed, MEDLINE, Scopus, PsyInfo, Cochrane, eLIBRARY.ru, http://ClinicalTrials.gov and http://www.clinicaltrialsregister.eu in July 2020 to identify studies that investigate the effect of the combination of angiotensin receptor blocker with chlorthalidone or hydrochlorothiazide on the systolic and diastolic blood pressure in patients with hypertension. Changes in systolic and diastolic blood pressure (BP) expressed as a weighted mean difference (WMD) were our primary outcomes. The random-effects method was chosen as the primary analysis and results were presented with a 95% confidence interval (CI). Sensitivity analysis was performed and bias was assessed.

Results: Our search returned 2745 titles. Of them, 51 full-text articles remained to be subjected to assessment. Comparisons of ARB/HCTZ versus ARB showed changes in BP of -6.89 (-8.09, -5.69) mmHg for systolic BP and - 3.67 (-4.15, -3.19) mmHg for diastolic BP. For the ARB/CTLD versus ARB/HCTZ comparison changes were - 6.30 (-7.30, -5.29) mmHg for systolic BP and - 3.57 (-4.17, 2.98) mmHg for diastolic BP.

Conclusion: Our analysis suggests a small but significant favor for CTLD in blood pressure control when compared to HCTZ. We believe it should be considered as a valuable alternative for HCTZ and an option for fixed dose combinations with an ARB although further research is required.

Keywords: Angiotensin receptor blocker; Chlorthalidone; Diuretics; Hydrochlorothiazide; Hypertension.

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Conflict of interest statement

SD, VP, KU, and EF are employees of Tchaikapharma High Quality Medicines Inc. The other authors report no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study selection process
Fig. 2
Fig. 2
Forest plot for systolic blood pressure ARB/HCTZ versus ARB
Fig. 3
Fig. 3
Forest plot for diastolic blood pressure ARB/HCTZ versus ARB
Fig. 4
Fig. 4
Forest plot for systolic blood pressure ARB/CTLD vs ARB/HCTZ
Fig. 5
Fig. 5
Forest plot for diastolic blood pressure ARB/CTLD vs ARB/HCTZ
See this image and copyright information in PMC

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