Comparative efficacy of antihypertensive agents in salt-sensitive hypertensive patients:a network me

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  Background Salt-sensitive hypertension(SSH)is a complex disease associated with many environmental and genetic factors.However,there are different medications to treat SSH that doctors are uncertain.Objectives To compare the effectiveness of different classes of antihypertensive drugs on the reduction of blood pressure.Methods The protocol of this network meta-analysis was registered in international prospective register of systematic reviews (PROSPERO)with registration number CRD42016052913.We systematically searched PubMed,EMBASE,Cochrane Library,Cochrane Central Register of Controlled Trials(CENTRAL),ClinicalTrials.gov and International Clinical Trials Registry Platform(ICTRP),Chinese National Knowledge Infrastructure(CNKI)and WANFANG database from inception to November 2016.Studies that compared the efficacy of two or more antihypertensive drugs,or placebo with adult salt-sensitive hypertensive patients were included.The primary outcomes were the changes of mean arterial pressure as well as systolic and diastolic blood pressure.Results Twenty-five studies (1935 individuals)were included in the network meta-analysis.The surface under the cumulative ranking curve(SUCRA)results showed that for SSH patients with obesity,CCBs combined with Metformin in moderate salt intake was significantly the most efficacious compared to placebo [standardized mean differences(SMD),95%credibility intervals(CI):26.66,12.60-40.16],ARBs [SMD,95%(CI):22.94,5.26-40.51]and other interventions;for SSH patients without other diseases,CCB with hydrochlorothiazide in moderate salt were the most efficacious than all the other antihypertensive drugs tested.After meta regression and subgroup analysis,we found that sample size,countries as well as diagnose method of SSH were contributed to the heterogeneity (65.38%).There were a relatively small inconsistency between direcct and indirect comparisons using node-split method.Conclusions:This network meta analysis indicated that CCBs combined with Metformin in moderate salt intake had the superior efficacy of reduction of blood pressure in SSH patients with obesity.For SSH patients without other diseases,CCBs combined with hydrochlorothiazide had priority to reduce blood pressure.
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