Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFRGS |
Texto Completo: | http://hdl.handle.net/10183/265536 |
Resumo: | Background The use of thiazide (T) diuretics for the treatment of hypertension may be associated with adverse metabolic effects, which can be minimized by combining thiazides with potassium-sparing (PS) diuretics. The additional blood pressure (BP)-lowering effect provided by the addition of a PS diuretic is unclear. Due to a large number of drugs in the T diuretics class, and the possible difference between them, there is a need to identify the best available evidence for health decision-making. This systematic review with network meta-analysis aims to compare the antihypertensive efficacy of T diuretics alone or in combination with a PS diuretic in patients with primary hypertension, as well as the safety of such drugs through the measurement of drug-related adverse events. Methods A comprehensive electronic search will be conducted in six electronic bibliographic databases (PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, Lilacs), a registration database (ClinicalTrials.gov), and Educational Resources Information Center (ERIC [ProQuest]), published from inception to the date of the search. The search will be updated towards the end of the review. A hand search of the reference sections of the included studies and cited studies will also be performed. In case of missing data, authors will be contacted by e-mail or academic social networking sites whenever possible. To be included in the review, studies must be double-blind randomized controlled trials evaluating T diuretics alone or in combination with PS diuretics in patients with primary hypertension. The primary outcome measure will be office BP. Ambulatory BP monitoring (ABPM), non-melanoma skin cancer, major adverse cardiovascular events, laboratory parameters, and the number of withdrawals will be included as secondary outcomes. The results will be quantitatively summarized using differences between the mean change from baseline or differences between means for quantitative outcomes and relative risk for dichotomous outcomes. Results will be presented as mean or relative risk with credible intervals through a league table. The treatments will also be ranked using the surface under the cumulative ranking curve method. The risk of bias will be assessed through the RoB 1.0 tool. Discussion To the best of our knowledge, this review will be the first to synthesize currently available evidence on the antihypertensive efficacy of different T diuretics alone or in combination with PS diuretics in adults with hypertension. The goals of hypertension treatment are to control high BP and to reduce associated cardiovascular morbidity and mortality, using the most appropriate therapy. Thiazides are widely used for pharmacological treatment due to their demonstrated effectiveness in reducing BP, favorable safety profile, and low cost. The results of this study will provide evidence regarding the best therapeutic strategies with T and PS diuretics, evidencing interventions with better antihypertensive efficacy and safety profile. Trial registration This systematic review and network meta-analysis was prospectively registered at the PROSPERO database (CRD42018118492). |
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Martins, Vitor MagnusZiegelmann, Patricia KlarmannHelal, Lucas Crescenti Abdalla SaadLacerda, Filipe Ferrari Ribeiro deLucca, Marcelo BalbinotFuchs, Sandra Cristina Pereira CostaFuchs, Flávio Danni2023-09-30T03:41:35Z20222046-4053http://hdl.handle.net/10183/265536001172647Background The use of thiazide (T) diuretics for the treatment of hypertension may be associated with adverse metabolic effects, which can be minimized by combining thiazides with potassium-sparing (PS) diuretics. The additional blood pressure (BP)-lowering effect provided by the addition of a PS diuretic is unclear. Due to a large number of drugs in the T diuretics class, and the possible difference between them, there is a need to identify the best available evidence for health decision-making. This systematic review with network meta-analysis aims to compare the antihypertensive efficacy of T diuretics alone or in combination with a PS diuretic in patients with primary hypertension, as well as the safety of such drugs through the measurement of drug-related adverse events. Methods A comprehensive electronic search will be conducted in six electronic bibliographic databases (PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, Lilacs), a registration database (ClinicalTrials.gov), and Educational Resources Information Center (ERIC [ProQuest]), published from inception to the date of the search. The search will be updated towards the end of the review. A hand search of the reference sections of the included studies and cited studies will also be performed. In case of missing data, authors will be contacted by e-mail or academic social networking sites whenever possible. To be included in the review, studies must be double-blind randomized controlled trials evaluating T diuretics alone or in combination with PS diuretics in patients with primary hypertension. The primary outcome measure will be office BP. Ambulatory BP monitoring (ABPM), non-melanoma skin cancer, major adverse cardiovascular events, laboratory parameters, and the number of withdrawals will be included as secondary outcomes. The results will be quantitatively summarized using differences between the mean change from baseline or differences between means for quantitative outcomes and relative risk for dichotomous outcomes. Results will be presented as mean or relative risk with credible intervals through a league table. The treatments will also be ranked using the surface under the cumulative ranking curve method. The risk of bias will be assessed through the RoB 1.0 tool. Discussion To the best of our knowledge, this review will be the first to synthesize currently available evidence on the antihypertensive efficacy of different T diuretics alone or in combination with PS diuretics in adults with hypertension. The goals of hypertension treatment are to control high BP and to reduce associated cardiovascular morbidity and mortality, using the most appropriate therapy. Thiazides are widely used for pharmacological treatment due to their demonstrated effectiveness in reducing BP, favorable safety profile, and low cost. The results of this study will provide evidence regarding the best therapeutic strategies with T and PS diuretics, evidencing interventions with better antihypertensive efficacy and safety profile. Trial registration This systematic review and network meta-analysis was prospectively registered at the PROSPERO database (CRD42018118492).application/pdfengSystematic reviews. London. Vol. 11 (2022), artigo 23, 9 p.HipertensãoTratamento farmacológicoDiuréticosInibidores de simportadores de cloreto de sódioPotássioRevisão sistemáticaMetanáliseHypertensionDrug therapyDiureticThiazidePotassium-sparingThiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysisEstrangeiroinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001172647.pdf.txt001172647.pdf.txtExtracted Texttext/plain45609http://www.lume.ufrgs.br/bitstream/10183/265536/2/001172647.pdf.txtd4573385ee22f6b95c5c8f21c44fc15bMD52ORIGINAL001172647.pdfTexto completo (inglês)application/pdf1463705http://www.lume.ufrgs.br/bitstream/10183/265536/1/001172647.pdf5ac9cc6a45713710c15e43714c510e55MD5110183/2655362023-10-01 03:38:28.10637oai:www.lume.ufrgs.br:10183/265536Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2023-10-01T06:38:28Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false |
dc.title.pt_BR.fl_str_mv |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis |
title |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis |
spellingShingle |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis Martins, Vitor Magnus Hipertensão Tratamento farmacológico Diuréticos Inibidores de simportadores de cloreto de sódio Potássio Revisão sistemática Metanálise Hypertension Drug therapy Diuretic Thiazide Potassium-sparing |
title_short |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis |
title_full |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis |
title_fullStr |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis |
title_full_unstemmed |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis |
title_sort |
Thiazide diuretics alone or in combination with a potassium-sparing diuretic on blood pressure-lowering in patients with primary hypertension : protocol for a systematic review and network meta-analysis |
author |
Martins, Vitor Magnus |
author_facet |
Martins, Vitor Magnus Ziegelmann, Patricia Klarmann Helal, Lucas Crescenti Abdalla Saad Lacerda, Filipe Ferrari Ribeiro de Lucca, Marcelo Balbinot Fuchs, Sandra Cristina Pereira Costa Fuchs, Flávio Danni |
author_role |
author |
author2 |
Ziegelmann, Patricia Klarmann Helal, Lucas Crescenti Abdalla Saad Lacerda, Filipe Ferrari Ribeiro de Lucca, Marcelo Balbinot Fuchs, Sandra Cristina Pereira Costa Fuchs, Flávio Danni |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Martins, Vitor Magnus Ziegelmann, Patricia Klarmann Helal, Lucas Crescenti Abdalla Saad Lacerda, Filipe Ferrari Ribeiro de Lucca, Marcelo Balbinot Fuchs, Sandra Cristina Pereira Costa Fuchs, Flávio Danni |
dc.subject.por.fl_str_mv |
Hipertensão Tratamento farmacológico Diuréticos Inibidores de simportadores de cloreto de sódio Potássio Revisão sistemática Metanálise |
topic |
Hipertensão Tratamento farmacológico Diuréticos Inibidores de simportadores de cloreto de sódio Potássio Revisão sistemática Metanálise Hypertension Drug therapy Diuretic Thiazide Potassium-sparing |
dc.subject.eng.fl_str_mv |
Hypertension Drug therapy Diuretic Thiazide Potassium-sparing |
description |
Background The use of thiazide (T) diuretics for the treatment of hypertension may be associated with adverse metabolic effects, which can be minimized by combining thiazides with potassium-sparing (PS) diuretics. The additional blood pressure (BP)-lowering effect provided by the addition of a PS diuretic is unclear. Due to a large number of drugs in the T diuretics class, and the possible difference between them, there is a need to identify the best available evidence for health decision-making. This systematic review with network meta-analysis aims to compare the antihypertensive efficacy of T diuretics alone or in combination with a PS diuretic in patients with primary hypertension, as well as the safety of such drugs through the measurement of drug-related adverse events. Methods A comprehensive electronic search will be conducted in six electronic bibliographic databases (PubMed/MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, Lilacs), a registration database (ClinicalTrials.gov), and Educational Resources Information Center (ERIC [ProQuest]), published from inception to the date of the search. The search will be updated towards the end of the review. A hand search of the reference sections of the included studies and cited studies will also be performed. In case of missing data, authors will be contacted by e-mail or academic social networking sites whenever possible. To be included in the review, studies must be double-blind randomized controlled trials evaluating T diuretics alone or in combination with PS diuretics in patients with primary hypertension. The primary outcome measure will be office BP. Ambulatory BP monitoring (ABPM), non-melanoma skin cancer, major adverse cardiovascular events, laboratory parameters, and the number of withdrawals will be included as secondary outcomes. The results will be quantitatively summarized using differences between the mean change from baseline or differences between means for quantitative outcomes and relative risk for dichotomous outcomes. Results will be presented as mean or relative risk with credible intervals through a league table. The treatments will also be ranked using the surface under the cumulative ranking curve method. The risk of bias will be assessed through the RoB 1.0 tool. Discussion To the best of our knowledge, this review will be the first to synthesize currently available evidence on the antihypertensive efficacy of different T diuretics alone or in combination with PS diuretics in adults with hypertension. The goals of hypertension treatment are to control high BP and to reduce associated cardiovascular morbidity and mortality, using the most appropriate therapy. Thiazides are widely used for pharmacological treatment due to their demonstrated effectiveness in reducing BP, favorable safety profile, and low cost. The results of this study will provide evidence regarding the best therapeutic strategies with T and PS diuretics, evidencing interventions with better antihypertensive efficacy and safety profile. Trial registration This systematic review and network meta-analysis was prospectively registered at the PROSPERO database (CRD42018118492). |
publishDate |
2022 |
dc.date.issued.fl_str_mv |
2022 |
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2023-09-30T03:41:35Z |
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Estrangeiro info:eu-repo/semantics/article |
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001172647 |
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2046-4053 001172647 |
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http://hdl.handle.net/10183/265536 |
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Systematic reviews. London. Vol. 11 (2022), artigo 23, 9 p. |
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