Article type
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Abstract
Background: The benefits of treating hypertension are well established. The major trials that demonstrated that treating hypertension reduces cardiovascular mortality used diuretics, beta-blockers, methyldopa or reserpine. Reserpine, one of the oldest antihypertensive drugs is still used for treating hypertension in developing countries but it has become obsolete in most developed countries. The reasons for its going out of favour may be the perception that it is less effective than newer antihypertensive agents and that it has a poor side-effect profile. The purpose of this systematic review is to search for and summarise the evidence relating to the effectiveness of reserpine in hypertension and the potential harm associated with its use.
Objectives: i. To determine whether reserpine monotherapy or in combination is as effective as other antihypertensive agents or combinations in reducing systolic and diastolic blood pressure (BP) and the frequency of cardiovascular events. ii. To assess the occurrence of side effects associated with reserpine in comparison with other antihypertensive agents.
Search strategy: Trials were sought for using the Cochrane Hypertension Review Group search strategy. The MEDLINE and EMBASE databases, the Cochrane Collaboration Central Register and the Cochrane Database of Abstracts of Reviews of Effectiveness (DARE) were searched. Further studies will be identified through manual searching of the Index Medicus and Excerpta Medica and checking reference lists. Unpublished literature will be identified through personal communication. Selection criteria: The review will include all randomised controlled trials comparing reserpine with placebo or active treatment in treating essential hypertension. The primary outcomes will be BP reduction, all-cause mortality, fatal and nonfatal cardiovascular events. The secondary outcomes will be frequency of depression or any other serious adverse events warranting withdrawal from trial.
Data collection and analysis: Two reviewers are independently selecting studies for inclusion, extracting data and assessing the quality of studies using a predesigned data extraction form. Each study will be summarised for the main outcomes. The chi-square test will be used to assess heterogeneity across the studies. The results will be analysed using the fixed effects and the random effects models. The robustness of the results will be tested for by carrying out sensitivity analyses.
Results: The database search has so far yielded over 150 articles. The systematic review is ongoing and the preliminary results will be presented at the 8th Cochrane Collaboration Colloquium in Cape Town in October 2000. Conclusion: The results of this systematic review are expected to provide the evidence to inform decision-makers in developed and developing countries on the place of reserpine in the treatment of hypertension.
Objectives: i. To determine whether reserpine monotherapy or in combination is as effective as other antihypertensive agents or combinations in reducing systolic and diastolic blood pressure (BP) and the frequency of cardiovascular events. ii. To assess the occurrence of side effects associated with reserpine in comparison with other antihypertensive agents.
Search strategy: Trials were sought for using the Cochrane Hypertension Review Group search strategy. The MEDLINE and EMBASE databases, the Cochrane Collaboration Central Register and the Cochrane Database of Abstracts of Reviews of Effectiveness (DARE) were searched. Further studies will be identified through manual searching of the Index Medicus and Excerpta Medica and checking reference lists. Unpublished literature will be identified through personal communication. Selection criteria: The review will include all randomised controlled trials comparing reserpine with placebo or active treatment in treating essential hypertension. The primary outcomes will be BP reduction, all-cause mortality, fatal and nonfatal cardiovascular events. The secondary outcomes will be frequency of depression or any other serious adverse events warranting withdrawal from trial.
Data collection and analysis: Two reviewers are independently selecting studies for inclusion, extracting data and assessing the quality of studies using a predesigned data extraction form. Each study will be summarised for the main outcomes. The chi-square test will be used to assess heterogeneity across the studies. The results will be analysed using the fixed effects and the random effects models. The robustness of the results will be tested for by carrying out sensitivity analyses.
Results: The database search has so far yielded over 150 articles. The systematic review is ongoing and the preliminary results will be presented at the 8th Cochrane Collaboration Colloquium in Cape Town in October 2000. Conclusion: The results of this systematic review are expected to provide the evidence to inform decision-makers in developed and developing countries on the place of reserpine in the treatment of hypertension.