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

Abstract

Background: Hypertension is a disease with significant clinical and socioeconomic 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.

Interaction and Compatibility Studies in the Development of Olmesartan Medoxomil and Hydrochlorothiazide Formulations under a Real Manufacturing Process

“…In this regard, patients with Stage 2 hypertension (systolic BP ≥ 160 mmHg or diastolic ≥ 100 mmHg), have achieved adequate control of BP only by drug combination therapy. Consequently, the combination of antihypertensive agents with complementary mechanisms of action [3][4][5][6] is recommended. Studies have reported that the addition of hydrochlorothiazide (HCT) improves the BP lowering effects of angiotensin II receptor blockers (ARBs) and, angiotensin-converting enzyme (ACE) inhibitors.…”

Tratamento da hipertensão arterial sistêmica: uma revisão de literatura integrativa sobre Hidroclorotiazida vs Clortalidona

“…A doença afeta atualmente cerca de 1 bilhão de pessoas ao redor do mundo, com a projeção de aumentar para 1.56 bilhões até 2025, dado o envelhecimento da população. No mundo inteiro, aproximadamente 17 milhões de mortes por ano estão relacionadas a alguma doença cardiovascular, sendo mais da metade dos casos devido a complicações resultantes da hipertensão (Filipova et al, 2020). Por definição, hipertensão arterial sistêmica é uma doença crônica não transmissível definida por níveis pressóricos, em que os benefícios do tratamento (não medicamentoso e/ou medicamentoso) superam os riscos.…”

“…Diversas meta-análises de estudos observacionais demonstram que o risco de morte cardiovascular aumenta continuamente a partir de 75mmHg de pressão diastólica usual e de 115mmHg de pressão sistólica usual, dobrando a cada 10mmHg no primeiro caso e a cada 20mmHg no segundo caso (Filipova et al, 2020). O risco relativo decorrente da elevação da PA acompanha um aumento progressivo do risco absoluto, pois acumulam os riscos basais hipertensão é uma síndrome complexa com múltiplas consequências hemodinâmicas, neuroendócrinas e metabólicas.…”

A Rapid HPLC Method for the Concurrent Determination of Several Antihypertensive Drugs from Binary and Ternary Formulations

“…Hypertension is a leading cause of mortality in elderly patients; however, due to the stresses of modern life, even younger people are now suffering from hypertension [1,2]. Globally, about 25% of the population are suffering from hypertension, and this is expected to increase to 30% by 2025 [3]. Different classes of antihypertensive agents are available to control hypertension.…”