Comparative effectiveness of physical activity interventions and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: protocol for a systematic review and network meta-analysis

Abstract

BackgroundThe prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension.MethodsA systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure.DiscussionThis study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy.Systematic review registrationPROSPERO CRD42017070579Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0791-9) contains supplementary material, which is available to authorized users.

Comparative efficacy of exercise and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: A network meta-analysis

“…These limitations may have been amplified because the study did not include DBP, did not conduct a full, formal systematic review strategy, nor publish a protocol specifying the details of the adopted methodology. We completed a full systematic review with a pre-published protocol 12 rather than drawing on existing meta-analyses. Clearly specifying the PICO can increase the extent to which the key transitivity assumption of network meta-analysis is met.…”

“…The methods have been described in detail in the published protocol. 12 Data and analysis scripts are available at https://osf.io/wpumg/.…”

“…In the present analysis we address these limitations by following our pre-published protocol. 12 We therefore aimed to examine the comparative efficacy on blood pressure reduction in people living with hypertension of physical activity interventions versus first-line anti-hypertensive medications (i.e. angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide-like diuretics) as both are considered viable first-line treatments.…”

Exercise versus fixed-dose combination therapy for cardiovascular risk factors control and atherosclerotic disease prevention: a network meta-analysis protocol

“…32 33 Thus, physical activity seems to be an attractive alternative to pharmacological intervention as a first-line treatment in managing cardiovascular risk factors such as hypertension and dyslipidaemia due to its comparatively less frequent and severe side effects; nevertheless, because of the low level of long-term adherence to exercise, more research addressing this issue is needed. 34 Among the pharmacological strategies, the fixeddose combination has emerged as a promising strategy, although its effectiveness in the prevention of all-cause mortality or ASCVD events is uncertain. 7 In fact, some authors recommend not using the polypill in isolation but as a part of a comprehensive ASCVD prevention strategy that includes, among other components, physical activity.…”

“…Thus, physical activity seems to be an attractive alternative to pharmacological intervention as a first-line treatment in managing cardiovascular risk factors such as hypertension and dyslipidaemia due to its comparatively less frequent and severe side effects; nevertheless, because of the low level of long-term adherence to exercise, more research addressing this issue is needed. 34 …”