Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals

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

doi:10.1002/14651858.CD011745.pub2

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Figure 1

PRISMA study flow diagram.

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Figure 2

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

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Figure 3

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

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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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Figure 5

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

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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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Figure 7

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

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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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Analysis 1.1

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

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Analysis 1.2

Comparison 1 Antihypertensive drug therapy versus control, Outcome 2 Non‐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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Analysis 1.4

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

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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)	⊕⊕⊕⊝ moderate^a
	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)	⊕⊕⊕⊝ moderate^a
	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)	⊕⊕⊕⊝ moderate^a
	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)

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]

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]

Comparison 2. Subgroup analysis, first‐line diuretic versus others

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