Efficacy of single‐pill combination in uncontrolled essential hypertension: A systematic review and network meta‐analysis

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2023-08, Vol.46 (8), p.886-898
• Main Authors: Xie, Mengxin, Tang, Tianjiao, Liang, Hongsheng
• Format: Article
• Language: English
• Subjects: Antihypertensives; Blood pressure; Cardiovascular disease; Clinical trials; control rate; Drugs; essential hypertension; Hypertension; Intervention; Meta-analysis; Monte Carlo simulation; Mortality; network meta‐analysis; Patient compliance; Response rates; Review; Reviews; single‐pill combination; Software; Uric acid
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.24082

This study aimed to evaluate the efficacy of single‐pill combination (SPC) antihypertensive drugs in patients with uncontrolled essential hypertension. Through Searching Pubmed, EMBASE, the Cochrane Library, and Web of Science collected only randomized controlled trials on the efficacy of single‐pill combination antihypertensive drugs in people with uncontrolled essential hypertension. The search period is from the establishment of the database to July 2022. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Assessment, and statistical analyses were performed using Review Manage 5.3 and Stata 15.1 software. This review ultimately included 32 references involving 16 273 patients with uncontrolled essential hypertension. The results of the network meta‐analysis showed that a total of 11 single‐pill combination antihypertensive drugs were included, namely: Amlodipine/valsartan, Telmisartan/amlodipine, Losartan/HCTZ, Candesartan/HCTZ, Amlodipine/benazepril, Telmisartan/HCTZ, Valsartan/HCTZ, Irbesartan/amlodipine, Amlodipine/losartan, Irbesartan/HCTZ, and Perindopril/amlodipine. According to SUCRA, Irbesartan/amlodipine may rank first in reducing systolic blood pressure (SUCRA: 92.2%); Amlodipine/losartan may rank first in reducing diastolic blood pressure (SUCRA: 95.1%); Telmisartan/amlodipine may rank first in blood pressure control rates (SUCRA: 83.5%); Amlodipine/losartan probably ranks first in diastolic response rate (SUCRA: 84.5%). Based on Ranking Plot of the Network, we can conclude that single‐pill combination antihypertensive drugs are superior to monotherapy, and ARB/CCB combination has better advantages than other SPC in terms of systolic blood pressure, diastolic blood pressure, blood pressure control rate, and diastolic response rate. However, due to the small number of some drug studies, the lack of relevant studies has led to not being included in this study, which may impact the results, and readers should interpret the results with caution. High blood pressure significantly increases the incidence of stroke, myocardial infarction, heart failure, and chronic kidney disease and is the leading cause of cardiovascular disease and premature death worldwide. Single‐pill combination preparations are a hot topic in the field of treatment of essential hypertension. In this study, the efficacy of different single‐pill combinations (SPCs) in the treatment of patients with uncontrolled essential hypertension w