It is still debated whether there are differences among the various
antihypertensive strategies in
heart failure prevention. We performed a network meta-analysis of recent trials in
hypertension aimed at investigating this issue.
METHODS: Randomized, controlled trials published from 1997 through 2009 in peer-reviewed journals indexed in the PubMed and EMBASE databases were selected. Selected trials included patients with
hypertension or a high-risk population with a predominance of patients with
hypertension.
RESULTS: A total of 223,313 patients were enrolled in the selected studies. Network meta-analysis showed that
diuretics (odds ratio [OR], 0.59; 95% credibility interval [CrI], 0.47-0.73),
angiotensin-converting enzyme (
ACE) inhibitors (OR, 0.71; 95% CrI, 0.59-0.85) and
angiotensin II receptor blockers (ARBs) (OR, 0.76; 95% CrI, 0.62-0.90) represented the most efficient classes of drugs to reduce the
heart failure onset compared with placebo. On the one hand, a
diuretic-based
therapy represented the best treatment because it was significantly more efficient than that based on
ACE inhibitors (OR, 0.83; 95% CrI, 0.69-0.99) and ARBs (OR, 0.78; 95% CrI, 0.63-0.97). On the other hand,
diuretics (OR, 0.71; 95% CrI, 0.60-0.86), ARBs (OR, 0.91; 95% CrI, 0.78-1.07), and
ACE inhibitors (OR, 0.86; 95% CrI, 0.75-1.00) were superior to
calcium channel blockers, which were among the least effective first-line agents in
heart failure prevention, together with β-blockers and α-blockers.
CONCLUSIONS: