Chlorthalidon e versus hydrochlorot hiazide with angiot ensin recepto r blocker in patients with hypertension – a meta-analysis

Abstract

The reduction in cardiovascular mortality and morbidity in patients treated for arterial hypertension (AH) is directly related to the magnitude of blood pressure (BP) reduction. Diuretics have proven useful for the prevention of cardiovascular complications in addition to a long history of safety and efficacy. The main aim of this meta-analysis is to compare the efficacy of the combination of angiotensin receptor blocker (ARB) and chlorthalidone (CTLD) or hydrochlorothiazide (HCTZ) in patients with AH. We searched electronic databases PubMed, MEDLINE, Scopus, PsyInfo, Cochrane, eLIBRARY.ru, http://ClinicalTrials.gov
and http://www.clinicaltrialsregister.eu in September 2018 to identify studies that investigate the effect of
the combination of ARB with CTLD or HCTZ on the systolic and diastolic BP (SBP and DBP) in patients
with AH. Changes in SBP and DBP expressed as a weighted mean difference (WMD) were our primary
outcomes. The random-effects method was chosen as the primary analysis and analysis and results were presented with a 95% confidence interval (CI). Sensitivity analysis was performed. 15 studies presenting data for 28 separate dose regimens remained to be included in the analysis comparing the efficacy of the combination of ARB and CLTD to the effect of the combined use of ARB and HCTZ in patients with AH. Comparisons of ARB/HCTZ versus ARB showed changes in BP of -6.89 (-8.09, -5.69) mmHg for SBP and -3.67 (-4.15, -3.19) mmHg for DBP. For the ARB/CTLD versus ARB/HCTZ comparison changes were -6.30 (-7.30, -5.29) mmHg for SBP and -3.57 (-4.17, 2.98) mmHg for DBP. Our analysis suggests prevalence for CTLD in BP 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.