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Meta-Analysis
. 2024 Dec;56(1):2362880.
doi: 10.1080/07853890.2024.2362880. Epub 2024 Jun 3.

Efficacy of angiotensin receptor blockers for nocturnal blood pressure reduction: a systematic review and meta-analysis

Jing Liu  1 , Wei Chen  1 , Shihuan Shao  1 , Yuanyuan Chen  1 , Hongyi Wang  1 , Yang Xi  1 , Luyan Wang  1
Affiliations
Meta-Analysis

Efficacy of angiotensin receptor blockers for nocturnal blood pressure reduction: a systematic review and meta-analysis

Jing Liu et al. Ann Med. 2024 Dec.

Abstract

Background: Nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients.

Objective: Nocturnal BP control is of great importance for cardiovascular risk reduction. This systematic review and meta-analysis aimed to explore the efficacy of angiotensin receptor blockers (ARBs) for nocturnal BP reduction in patients with mild to moderate hypertension.

Methods: PICOS design structure was used to formulate the data extraction. All statistical calculations and analyses were performed with R.

Results: Seventy-seven studies with 13,314 participants were included. The overall analysis indicated that nocturnal BP drop varied considerably among different ARBs. Allisartan (13.04 [95% CI (-18.41, -7.68)] mmHg), olmesartan (11.67 [95% CI (-14.12, -9.21)] mmHg), telmisartan (11.11 [95% CI (-12.12, -10.11)] mmHg) were associated with greater reduction in nocturnal systolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1. While, the variation tendency of last 4-6 h ambulatory BP was basically consistent with nocturnal BP. Additionally, allisartan showed improvement effect in the proportion of patients with dipping BP pattern.

Conclusions: This study demonstrates that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nighttime BP more than daytime BP and improve the dipping pattern.

Keywords: Angiotensin II AT1 receptor antagonists (ARBs); hypertension; meta-analysis; nocturnal blood pressure.

Plain language summary

This meta-analysis explores the efficacy of Angiotensin II AT1 receptor antagonists (ARBs) on nocturnal blood pressure (BP) reduction in mild to moderate hypertension.The results demonstrate that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs.Allisartan can reduce nighttime BP more effectively than daytime BP, which also improve the dipping pattern.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1.
Figure 1.
PRISMA diagram of the literature selection.
Figure 2.
Figure 2.
Nocturnal ambulatory blood pressure drops (Fifty-two studies with 7190 patients).
Figure 3.
Figure 3.
Nocturnal-diurnal blood pressure drop ratio (Forty-four studies with 4694 patients).
Figure 4.
Figure 4.
Last 4-6 h ambulatory blood pressure drops (Nine studies with 2412 patients).
Figure 5.
Figure 5.
The proportion of patients exhibiting a dipper pattern of BP variation (Six studies with 595 patients).
See this image and copyright information in PMC

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