A 16-week, randomized, double-blind, placebo-controlled, crossover trial to quantify the combined effect of an angiotensin-converting enzyme inhibitor and a β-blocker on blood pressure reduction

Wald, David S; Law, Malcolm; Mills, S. B.; Bestwick, Jonathan P.; Morris, Joan K.; Wald, Nicholas

doi:10.1016/j.clinthera.2008.11.003

Cited by 4 publications

(1 citation statement)

References 19 publications

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“…In order to assess the impact of enhanced medication prescription, number of medication changes was plotted against changes in BP and showed that increased numbers of medication changes were weakly correlated with reduced BP ( S22 Fig ). Whatever the mechanism, the literature suggests that a 6 mmHg reduction in sBP, as observed in higher-intensity interventions, would reduce subsequent stroke by more than 20% [ 56 ]. Considering the content of such interventions is an important part of decision-making in the implementation of self-monitoring.…”

Section: Discussionmentioning

confidence: 99%

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis

et al. 2017

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BackgroundSelf-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension.Methods and findingsMedline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes—change in mean clinic or ambulatory BP and proportion controlled below target at 12 months—were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (−3.2 mmHg, [95% CI −4.9, −1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (−1.0 mmHg [−3.3, 1.2]), to a 6.1 mmHg (−9.0, −3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic −0.2 mmHg [−2.2, 1.8]; ambulatory 1.1 mmHg [−0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies.ConclusionsSelf-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions.

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Section: Discussionmentioning

confidence: 99%

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis

et al. 2017

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Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension

Wong

Boyda

Wright

2016

Cochrane Database of Systematic Reviews

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This review provides low quality evidence that in people with mild to moderate hypertension, beta-1 selective blockers lowered BP by an average of -10/-8 mmHg and reduced heart rate by 11 beats per minute as compared to placebo. The effect of beta-1 blockers at peak hours, -12/-9 mmHg, was greater than the reduction at trough hours, -8/-7 mmHg. Beta-1 selective blockers lowered BP by a greater magnitude than dual receptor beta-blockers and partial agonist beta-blockers, lowered BP similarly to nonselective beta-blockers. Beta-1 selective blockers lowered SBP by a similar degree and lowered DBP by a greater degree than diuretics, angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Because DBP is lowered by a similar extent to SBP, beta-1 selective blockers do not reduce pulse pressure.

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Combination Therapy Versus Monotherapy in Reducing Blood Pressure: Meta-analysis on 11,000 Participants from 42 Trials

Wald

Law

Morris

et al. 2009

The American Journal of Medicine

809

406

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A 16-week, randomized, double-blind, placebo-controlled, crossover trial to quantify the combined effect of an angiotensin-converting enzyme inhibitor and a β-blocker on blood pressure reduction

Cited by 4 publications

References 19 publications

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis

Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension

Combination Therapy Versus Monotherapy in Reducing Blood Pressure: Meta-analysis on 11,000 Participants from 42 Trials

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