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Eplerenona para la hipertensión
Tina SC Tam, May HY Wu, Sarah C Masson, Matthew P Tsang, Sarah N Stabler, Angus Kinkade, Anthony Tung, Aaron M Tejani | 28 febrero 2017

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Temas

Flow diagram of the study selection

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Figure 1

Flow diagram of the study selection

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 1: 24‐h ambulatory systolic blood pressure

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Analysis 1.1

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 1: 24‐h ambulatory systolic blood pressure

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 2: 24‐h ambulatory diastolic blood pressure

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Analysis 1.2

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 2: 24‐h ambulatory diastolic blood pressure

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 3: Clinic‐measured systolic blood pressure

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Analysis 1.3

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 3: Clinic‐measured systolic blood pressure

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 4: Clinic‐measured diastolic blood pressure

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Analysis 1.4

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 4: Clinic‐measured diastolic blood pressure

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 5: Serum uric acid

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Analysis 1.5

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 5: Serum uric acid

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 6: Adverse events

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Analysis 1.6

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 6: Adverse events

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 7: 24‐h ambulatory systolic blood pressure in adolescents (subgroup analysis)

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Analysis 1.7

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 7: 24‐h ambulatory systolic blood pressure in adolescents (subgroup analysis)

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Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 8: 24‐h ambulatory diastolic blood pressure in adolescents (subgroup analysis)

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Analysis 1.8

Comparison 1: Uric acid (UA)‐lowering drug vs placebo, Outcome 8: 24‐h ambulatory diastolic blood pressure in adolescents (subgroup analysis)

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Summary of findings 1. Uric acid‐lowering drug compared to placebo for people with hyperuricaemia

Uric acid‐lowering drug compared to placebo for hyperuricaemia in people with hypertension

Patient or population: hyperuricaemia in people with hypertension
Setting: several sites in the USA
Intervention: uric acid‐lowering drugs
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Matched placebo

Risk difference with UA‐lowering drug

24‐h ambulatory systolic BP

The mean change in BP across control groups ranged from: ‐3.4 to 1.9 mmHg

MD was 6.19 mmHg lower

(12.82 lower to 0.45 higher)

‐

229 participants' data
(3 RCTs)

⊕⊕⊝⊝
Lowa,b

24‐h ambulatory diastolic BP

The mean change in BP across control groups ranged from: ‐2.7 to 1.3 mmHg

MD was 3.92 mmHg lower

(9.19 lower to 1.36 higher)

‐

229 participants' data
(3 RCTs)

⊕⊕⊝⊝
Lowa,b

Clinic‐measured systolic BP

The mean change in BP across control groups ranged from: ‐2 to 1.7 mmHg

MD was 8.43 mmHg lower

(15.24 lower to 1.62 lower)

‐

120 participants' data
(2 RCTs)

⊕⊕⊝⊝
Lowa,b

Clinic‐measured diastolic BP

The mean change in BP across control groups ranged from: ‐2.4 to 1.6 mmHg

MD was 6.45 mmHg lower

(13.6 lower to 0.7 higher)

‐

120 participants' data
(2 RCTs)

⊕⊕⊝⊝
Lowa,b

Serum UA

The mean change in serum UA across control groups ranged from: ‐0.3 to 0.2 mg/dL

MD was 3.09 mg/dL lower

(3.76 lower to 2.43 lower)

‐

223 participants' data
(3 RCTs)

⊕⊕⊕⊕
High

Adverse events

(withdrawals due to side effects)

18 per 1000

34 per 1000
(8 to 147)

RR 1.86
(95% CI 0.43 to 8.10)

241 participants' data
(3 RCTs)

⊕⊕⊝⊝
Lowa,c

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; MD: mean difference; RR: risk ratio; RCT: randomised controlled trial; UA: uric acid; BP: blood pressure; h: hour.

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aDowngraded for wide CIs
bDowngraded for high unexplained heterogeneity
cDowngraded for small number of events and incomplete reporting

Figuras y tablas -
Summary of findings 1. Uric acid‐lowering drug compared to placebo for people with hyperuricaemia
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Comparison 1. Uric acid (UA)‐lowering drug vs placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 24‐h ambulatory systolic blood pressure Show forest plot

3

Mean Difference (IV, Random, 95% CI)

‐6.19 [‐12.82, 0.45]

1.2 24‐h ambulatory diastolic blood pressure Show forest plot

3

Mean Difference (IV, Random, 95% CI)

‐3.92 [‐9.19, 1.36]

1.3 Clinic‐measured systolic blood pressure Show forest plot

2

Mean Difference (IV, Random, 95% CI)

‐8.43 [‐15.24, ‐1.62]

1.4 Clinic‐measured diastolic blood pressure Show forest plot

2

Mean Difference (IV, Random, 95% CI)

‐6.45 [‐13.60, 0.70]

1.5 Serum uric acid Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

‐3.20 [‐3.60, ‐2.80]

1.6 Adverse events Show forest plot

3

Risk Ratio (IV, Fixed, 95% CI)

Subtotals only

1.7 24‐h ambulatory systolic blood pressure in adolescents (subgroup analysis) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

‐9.43 [‐13.12, ‐5.74]

1.8 24‐h ambulatory diastolic blood pressure in adolescents (subgroup analysis) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

‐6.30 [‐9.91, ‐2.69]
Figuras y tablas -
Comparison 1. Uric acid (UA)‐lowering drug vs placebo
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