Comparative efficacy of different types of antihypertensive drugs in reversing left ventricular hypertrophy as determined with echocardiography in hypertensive patients: A network meta‐analysis of randomized controlled trials

• Published in: The journal of clinical hypertension (Greenwich, Conn.) Vol. 22; no. 12; pp. 2175 - 2183
• Main Authors: Chen, Jian‐Shu, Pei, Ying, Li, Cai‐e, Li, Yin‐ning, Wang, Qiong‐ying, Yu, Jing
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01.12.2020
• Subjects: Angiotensin Receptor Antagonists - therapeutic use; Antihypertensive Agents - therapeutic use; antihypertensive drug; Bayesian network analysis; Calcium Channel Blockers - therapeutic use; Echocardiography; Humans; hypertension; Hypertension - complications; Hypertension - drug therapy; Hypertrophy, Left Ventricular - drug therapy; left ventricular hypertrophy; Network Meta-Analysis; Randomized Controlled Trials as Topic; Review Paper; Reviews and Meta‐analyses; antihypertensive drug; Bayesian network analysis; left ventricular hypertrophy; hypertension
• ISSN: 1524-6175; 1751-7176
• DOI: 10.1111/jch.14047

Reversing left ventricular hypertrophy (LVH) can reduce the incidence of adverse cardiovascular events. However, there is no clear superiority–inferiority differentiation between angiotensin‐converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta‐blockers (BB), calcium channel blockers (CCB), and diuretics in reversing LVH in hypertensive patients. To provide further evidence for choosing the optimal antihypertensive drug for improving LVH, we performed a network meta‐analysis of randomized controlled trials (RCTs) based on the Cochrane library database, Embase, and Pubmed, and identified 49 studies involving 5402 patients that were eligible for inclusion. It was found that ARB could improve LVH in hypertensive patients more effectively than CCB (MD −4.07, 95%CI −8.03 to −0.24) and BB (MD −4.57, 95%CI −8.07 to −1.12). Matched comparison of renin‐angiotensin system inhibitors (RASi) showed that the effect of ACEI in reducing left ventricular mass index (LVMi) was not effective as that of ARB (MD −3.72, 95%CI −7.52 to −0.11). The surface under the cumulative ranking for each intervention indicated that the use of ARB was more effective among the different types of antihypertensive drugs (97%). This network meta‐analysis revealed that the use of ARB in antihypertensive therapy could achieve better efficacy in reversing LVH in hypertensive patients.