Comparative efficacy of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke:a network Meta-analysis
AIM To explore the efficacy of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke.METHODS A literature search was conducted for randomized controlled trials(RCTs)regarding antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke from databases involving China National Knowledge Infrastructure(CNKI),VIP database,WanFang database,Cochrane Library,PubMed and Embase databases from their inception to 2023.The quality and risk of bias of the literature were assessed by the Cochrane Collaboration's tool(version 5.2).The evaluation indicators were stroke recurrence rate(SRR)or stroke mortality rate(SMR).The effect size was measured using odds ratios(OR)with a 95％confidence interval(95％CI)and the surface under the cumulative ranking curve(SUCRA)for evaluation.RESULTS A total of 38 RCTs included 44091 patients,involving 13 kinds of therapy such as placebo or basic treatment,angiotensin-converting enzyme inhibitor(ACEI),calcium channel blocker(CCB),diuretic(Diu),angiotensin Ⅱ receptor antagonist(ARB),β-receptor blocker(BB),CCB+Diu,Diu+central nervous system hypotension(CNS),ACEI+CCB,ACEI+folic acid(FA),ARB+Diu,ACEI+Diu,and ACEI+BB.None of the literature described the completeness of the results,selective reporting,or other biases.Network Meta-analysis 95％CI showed,as for SRR,ARB was superior to Placebo,Diu,and CCB,ACEI+Diu was superior to ACEI,Diu+CNS,and ACEI+CCB was superior to CCB,ACEI,Diu+CNS.In reducing SMR,ARB and ACEI were superior to CCB,and ARB and ACEI+CCB were superior to BB.In term of reducing SRR,the SUCRA order of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke was as follows:ACEI+CCB＞ARB＞ACEI+Diu＞CCB+Diu＞BB＞Placebo＞ACEI+FA＞ACEI+BB＞ARB+Diu＞Diu＞CCB＞ACEI＞Diu+CNS.In reducing SMR,the SUCRA order was:ARB＞ACEI+CCB＞Diu+CNS＞ACEI+BB＞Placebo＞CCB＞ACEI＞BB.CONCLUSION Based on the existing clinical evidence,ACEI+CCB and ARB are recommended for the selection of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke.However,further multicenter,large-sample,high-quality RCTs are needed to validate these findings.
国家科技期刊平台
NSTL
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