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Cochrane Database of Systematic Reviews

Farmacoterapia antihipertensiva para la prevención de la muerte cardíaca súbita en pacientes hipertensos

Información

DOI:
https://doi.org/10.1002/14651858.CD011745.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 10 marzo 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Hipertensión

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Garry Taverny

    Correspondencia a: UMR5558 ‐ Service de Pharmacologie Clinique et Essais Thérapeutiques, Université Claude Bernard Lyon 1, Lyon, France

    [email protected]

  • Yanis Mimouni

    EPICIME (Epidémiologie, Pharmacologie, Investigation Clinique et Information médicale, Mère‐Enfant), Clinical Investigation Center, Hospices Civils de Lyon CIC1407/INSERM/UCB LyonI/UMR5558, Bron, France

  • Anne LeDigarcher

    Lyon, France

  • Philippe Chevalier

    Lyon, France

  • Lutgarde Thijs

    Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

  • James M Wright

    Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada

  • Francois Gueyffier

    UMR5558, CNRS et Université Claude Bernard ‐ Service de Pharmacologie Clinique et Essais Thérapeutiques, Hopital Cardio‐Vasculaire et Pneumologique Louis Pradel, Lyon, France

Contributions of authors

Garry Taverny: drafted the protocol, obtained copies of studies, selected studies for inclusion, extracted data from reports, entered data into RevMan, carried out the analysis, interpreted the analysis, drafted the final review and will update the review.

Yanis Mimouni: selected studies for inclusion and extracted data from reports.

Anne LeDigarcher: selected studies for inclusion and extracted data from reports.

Pr. Philippe Chevalier: formulated the idea for the review.

Lutgarde Thijs: extracted data from studies.

Pr. James M Wright: extracted data from studies, interpreted the analysis, drafted the final review and will update the review.

Pr. François Gueyffier: interpreted the analysis, drafted the final review, extracted data from the INDANA database for related trials and will update the review.

Pr. François Gueyffier formulated the idea for the review, and every review author contributed to the draft of the protocol.

Sources of support

Internal sources

  • University of British Columbia, Vancouver, Canada.

  • Université Claude Bernard Lyon 1, France.

External sources

  • No sources of support supplied

Declarations of interest

Garry Taverny: nothing to declare.

Yanis Mimouni: nothing to declare.

Anne LeDigarcher: nothing to declare.

Pr. Philippe Chevalier: nothing to declare.

Lutgarde Thijs: nothing to declare.

Pr. James M Wright: nothing to declare.

Pr. François Gueyffier: nothing to declare.

Acknowledgements

We would like to thank the Cochrane Hypertension Group, especially Ciprian Jauca and Douglas Salzwedel, for assistance provided.

Version history

Published

Title

Stage

Authors

Version

2016 Mar 10

Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals

Review

Garry Taverny, Yanis Mimouni, Anne LeDigarcher, Philippe Chevalier, Lutgarde Thijs, James M Wright, Francois Gueyffier

https://doi.org/10.1002/14651858.CD011745.pub2

2015 Jun 14

Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals

Protocol

Garry Taverny, Yanis Mimouni, James M Wright, Francois Gueyffier

https://doi.org/10.1002/14651858.CD011745

Differences between protocol and review

Anne LeDigarcher, Pr. Philippe Chevalier and Lutgarde Thijs joined the team of review authors and contributed to this review.

We have made the following changes to the inclusion criteria:

  • Added the requirement that “> 50% [of] study participants had to have hypertension” (added to be more inclusive and more explicit).

  • Added the requirement that trials report primary outcome in intervention and control groups (added so that irrelevant trials could be excluded).

  • Deleted the primary outcome “specific cause of SCD when known” (changed because if cause of death were known, it would not be reported as SCD).

  • Deleted secondary outcome "change in blood pressure at study end" (judged not relevant to the objective of this review).

  • Added "withdrawals due to adverse effects" as secondary outcome (important to include harms data in all reviews if possible).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

PRISMA study flow diagram.
Figuras y tablas -
Figure 1

PRISMA study flow diagram.

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Funnel plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.1 Sudden cardiac death.
Figuras y tablas -
Figure 2

Funnel plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.1 Sudden cardiac death.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

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.
Figuras y tablas -
Figure 4

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

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Forest plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.1 Sudden cardiac death.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.1 Sudden cardiac death.

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Forest plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.2 Non‐fatal myocardial infarction.
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Figure 6

Forest plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.2 Non‐fatal myocardial infarction.

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Forest plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.3 Fatal myocardial infarction.
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Figure 7

Forest plot of comparison: 1 Antihypertensive drug therapy vs control, outcome: 1.3 Fatal myocardial infarction.

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Forest plot of comparison: 3 Subgroup analysis, first‐line diuretic versus others, outcome: 3.1 Sudden cardiac death.
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Figure 8

Forest plot of comparison: 3 Subgroup analysis, first‐line diuretic versus others, outcome: 3.1 Sudden cardiac death.

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Comparison 1 Antihypertensive drug therapy versus control, Outcome 1 Sudden cardiac death.
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Analysis 1.1

Comparison 1 Antihypertensive drug therapy versus control, Outcome 1 Sudden cardiac death.

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Comparison 1 Antihypertensive drug therapy versus control, Outcome 2 Non‐fatal myocardial infarction.
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Analysis 1.2

Comparison 1 Antihypertensive drug therapy versus control, Outcome 2 Non‐fatal myocardial infarction.

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Comparison 1 Antihypertensive drug therapy versus control, Outcome 3 Fatal myocardial infarction.
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Analysis 1.3

Comparison 1 Antihypertensive drug therapy versus control, Outcome 3 Fatal myocardial infarction.

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Comparison 1 Antihypertensive drug therapy versus control, Outcome 4 Withdrawals due to adverse effects.
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Analysis 1.4

Comparison 1 Antihypertensive drug therapy versus control, Outcome 4 Withdrawals due to adverse effects.

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Comparison 2 Subgroup analysis, first‐line diuretic versus others, Outcome 1 Sudden cardiac death.
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Analysis 2.1

Comparison 2 Subgroup analysis, first‐line diuretic versus others, Outcome 1 Sudden cardiac death.

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Summary of findings for the main comparison. Antihypertensive pharmacotherapy versus control for prevention of sudden cardiac death in hypertensive individuals

Antihypertensive pharmacotherapy versus control for prevention of sudden cardiac death in hypertensive individuals

Patient or population: people with hypertension (defined as baseline systolic resting blood pressure ≥ 140 mmHg and/or resting diastolic blood pressure ≥ 90 mmHg)
Setting: primary care outpatient
Intervention: antihypertensive pharmacotherapy (first‐line thiazide, angiotensin‐converting enzyme inhibitor, calcium channel blocker or beta‐blocker)
Comparison: placebo or no treatment

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with control

Risk with antihypertensive pharmacotherapy

Sudden cardiac death

(mean follow‐up: 4.2 years)

Study population

RR 0.96
(0.81 to 1.15)

39908
(15 RCTs)

⊕⊕⊕⊝
moderatea

13 per 1000

12 per 1000
(10 to 14)

Non‐fatal myocardial infarction (mean follow‐up: 4.2 years)

Study population

RR 0.85
(0.74 to

0.98)

39908
(15 RCTs)

⊕⊕⊕⊝
moderatea

20 per 1000

17 per 1000
(15 to 20)

Fatal myocardial infarction (mean follow‐up: 4.2 years)

Study population

RR 0.75
(0.62 to

0.90)

39908
(15 RCTs)

⊕⊕⊕⊝
moderatea

12 per 1000

9 per 1000
(7 to 11)

*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; RR: risk ratio

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

aDowngraded 1 level for imprecision (wide confidence intervals)

Figuras y tablas -
Summary of findings for the main comparison. Antihypertensive pharmacotherapy versus control for prevention of sudden cardiac death in hypertensive individuals
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Comparison 1. Antihypertensive drug therapy versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Sudden cardiac death Show forest plot

15

39908

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.81, 1.15]

2 Non‐fatal myocardial infarction Show forest plot

15

39908

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.74, 0.98]

3 Fatal myocardial infarction Show forest plot

15

39908

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.62, 0.90]

4 Withdrawals due to adverse effects Show forest plot

10

32026

Risk Ratio (M‐H, Random, 95% CI)

2.06 [1.11, 3.83]
Figuras y tablas -
Comparison 1. Antihypertensive drug therapy versus control
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Comparison 2. Subgroup analysis, first‐line diuretic versus others

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Sudden cardiac death Show forest plot

15

38281

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.83, 1.19]

1.1 First‐line diuretic

10

17912

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.82, 1.43]

1.2 First‐line other antihypertensive drugs

5

20369

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.74, 1.19]
Figuras y tablas -
Comparison 2. Subgroup analysis, first‐line diuretic versus others
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