Comparative efficacy of anti-hypertensive agents in salt-sensitive hypertensive patients: A network meta-analysis

Qi H1, Liu Z1, Cao H1, Sun W2, Liu B1, Peng W1, Zhang L1
1School of Public Health, Capital Medical University, 2Beijing Luhe Hospital, Capital Medical University

Background: Salt-sensitive hypertension is a complex disease associated with many environmental and genetic factors. However, there are so many different medications to treat salt-sensitive hypertension that doctors are uncertain.

Objectives: To compare the effectiveness of different classes of antihypertensive drugs on the reduction of blood pressure.

Methods: The protocol of this network meta-analysis was registered in international prospective register of systematic reviews (PROSPERO) with registration number CRD42016052913. We systematically searched PubMed, EMBASE, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and International Clinical Trials Registry Platform(ICTRP) from inception to November 2016. Studies that compared the efficacy of two or more anti-hypertensive drugs, or placebo with adult salt-sensitive hypertensive patients were included. The primary outcomes were the changes of mean arterial pressure as well as systolic and diastolic blood pressure.

Results: 22 studies (1686 individuals) were finally included in the network meta-analysis. However, three studies extracted data twice (different salt intake) so the total included studies were 25. The surface under the cumulative ranking curve (SUCRA) results showed that CCBs combined with Metformin in moderate salt intake was significantly the most efficacious compared to placebo [standardised mean differences (SMD), 95% credibility intervals (CI): 26.66, 12.60-40.16], ARBs [SMD, 95% (CI): 22.94, 5.26-40.51] and other interventions. After meta regression and subgroup analysis, we found that sample size, countries as well as diagnose method of salt-sensitive hypertension were lead to the 63.58% of heterogeneity.

Conclusions: This network meta analysis indicated that CCBs combined with Metformin in moderate salt intake had the superior efficacy of reduction of blood pressure in salt-sensitive hypertension.

Funding: the Natural Science Foundation of China (81373076); Beijing Natural Science Foundation (7172023)