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Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide - which is the better alternative?
Elena Filipova1, Stela Dineva2, Katya Uzunova2
1Science Department, Tchaikapharma High Quality Medicines, Inc, 1 G.M. Dimitrov Boulevard, 1172, Sofia, Bulgaria. e.filipova.hq@tchaikapharma.com.
Insights
Chlorthalidone (CTLD) combined with an angiotensin receptor blocker (ARB) offers slightly better blood pressure control than hydrochlorothiazide (HCTZ) combined with an ARB. This combination is a valuable alternative for hypertension management.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Hypertension poses significant clinical and socio-economic burdens.
- Effective blood pressure reduction is key to mitigating cardiovascular risks.
- Diuretics are established, safe, and effective in preventing cardiovascular complications.
Purpose of the Study:
- To compare the efficacy of angiotensin receptor blocker/chlorthalidone (ARB/CTLD) versus angiotensin receptor blocker/hydrochlorothiazide (ARB/HCTZ) combinations.
- To evaluate blood pressure reduction in hypertensive patients treated with these combination therapies.
- To determine if CTLD offers superior blood pressure control compared to HCTZ when used with an ARB.
Main Methods:
- A comprehensive literature search was performed across multiple electronic databases.
- Studies investigating ARB/CTLD and ARB/HCTZ combinations for hypertension were identified.
- Systolic and diastolic blood pressure changes were analyzed using a random-effects model, with results presented as weighted mean differences and 95% confidence intervals.
Main Results:
- The meta-analysis included studies comparing ARB/HCTZ and ARB/CTLD combinations.
- ARB/HCTZ showed significant reductions in systolic BP (-6.89 mmHg) and diastolic BP (-3.67 mmHg).
- ARB/CTLD demonstrated a small but statistically significant advantage over ARB/HCTZ in reducing both systolic (-6.30 mmHg) and diastolic (-3.57 mmHg) blood pressure.
Conclusions:
- The combination of ARB/CTLD demonstrates a modest but significant benefit in blood pressure control compared to ARB/HCTZ.
- CTLD should be considered a valuable alternative to HCTZ for hypertension treatment.
- Further research is warranted to fully establish the role of ARB/CTLD fixed-dose combinations.
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.
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