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Journal of Dentistry Nov 2022To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in pediatric patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in pediatric patients.
DATA SOURCES
Electronic and hand searches were conducted to locate Randomized Controlled Trials (RCTs) reporting on objective and subjective evaluation of anxiety and behavior of children up to 12 years of age. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool (RoB 2.0 Tool), were performed independently and in duplicate for all included studies. Mean differences and standard deviations were used to summarize the data from each study and meta-analyses were conducted with studies of limited heterogeneity.
STUDY SELECTION
A total of 708 papers were identified and screened, 122 retrieved for full text appraisal and 62 finally included. Results suggested that all basic BMTs have acceptable effectiveness on pediatric patients' anxiety, fear and behavior during dental treatment. Meta-analysis showed a statistically significant difference in favor of distraction for subjective anxiety using Facial scale (Mean diff.: 2.78; 95% CI: -3.08, -0.53; p = 0.005) and Modified Child Dental Anxiety Scale (Mean diff.: 12.76; 95% CI: -6.09, -4.47; p = 0.001) and a non-significant difference for heart rate (Mean diff.: 1.70; 95% CI: -6.54, 0.46; p = 0.09). Music significantly reduced heart rate when compared to a control comparator, underlining the superiority of the BMT (Mean diff.: 2.71; 95% CI: -3.70, -0.59; p = 0.007).
CONCLUSIONS
Limited evidence about efficacy of one technique over another raises important issues on the topic for future research regarding the management of the child patient in the dental setting of the 21st century.
CLINICAL SIGNIFICANCE
Behavioral management comprises a challenge for clinicians, who need to be familiar with a range of techniques to meet patients' needs at individual level and be flexible in their implementation. Appropriate technique should incorporate patients' personality and parents' active involvement, within the contents of the changes in modern societies.
Topics: Child; Humans; Pediatric Dentistry; Anxiety; Anxiety Disorders
PubMed: 36152953
DOI: 10.1016/j.jdent.2022.104303 -
The American Journal of Sports Medicine Dec 2019Comprehensive studies evaluating quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction are lacking. The optimal choice of graft between... (Meta-Analysis)
Meta-Analysis
Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Outcomes for Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring-Tendon Autografts.
BACKGROUND
Comprehensive studies evaluating quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction are lacking. The optimal choice of graft between bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and QT is still debatable.
HYPOTHESIS
The current literature supports the use of QT as a strong autograft with good outcomes when used in ACL reconstruction.
STUDY DESIGN
Meta-analysis; Level of evidence, 2.
METHODS
A systematic search of the literature was performed in PubMed, MEDLINE, Cochrane, and Ovid databases to identify published articles on clinical studies relevant to ACL reconstruction with QT autograft and studies comparing QT autograft versus BPTB and HT autografts. The results of the eligible studies were analyzed in terms of instrumented laxity measurements, Lachman test, pivot-shift test, Lysholm score, objective and subjective International Knee Documentation committee (IKDC) scores, donor-site pain, and graft failure.
RESULTS
Twenty-seven clinical studies including 2856 patients with ACL reconstruction met the inclusion criteria. Comparison of 581 QT versus 514 BPTB autografts showed no significant differences in terms of instrumented mean side-to-side difference ( = .45), Lachman test ( = .76), pivot-shift test grade 0 ( = .23), pivot-shift test grade 0 or 1 ( = .85), mean Lysholm score ( = .1), mean subjective IKDC score ( = .36), or graft failure ( = .50). However, outcomes in favor of QT were found in terms of less donor-site pain (risk ratio for QT vs BPTB groups, 0.25; 95% CI, 0.18-0.36; < .00001). Comparison of 181 QT versus 176 HT autografts showed no significant differences in terms of instrumented mean side-to-side difference ( = .75), Lachman test ( = .41), pivot-shift test grade 0 ( = .53), Lysholm score less than 84 ( = .53), mean subjective IKDC score ( = .13), donor-site pain ( = .40), or graft failure ( = .46). However, outcomes in favor of QT were found in terms of mean Lysholm score (mean difference between QT and HT groups, 3.81; 95% CI, 0.45-7.17; = .03).
CONCLUSION
QT autograft had comparable clinical and functional outcomes and graft survival rate compared with BPTB and HT autografts. However, QT autograft showed significantly less harvest site pain compared with BPTB autograft and better functional outcome scores compared with HT autograft.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Bone-Patellar Tendon-Bone Grafting; Female; Hamstring Tendons; Humans; Knee Joint; Male; Patellar Ligament; Quadriceps Muscle; Tendons
PubMed: 30790526
DOI: 10.1177/0363546518825340 -
Arthroscopy : the Journal of... Jul 2023To systematically review the literature to compare the efficacy and safety of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and hyaluronic acid... (Meta-Analysis)
Meta-Analysis Review
Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis.
PURPOSE
To systematically review the literature to compare the efficacy and safety of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and hyaluronic acid (HA) injections for the treatment of knee osteoarthritis (OA).
METHODS
A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I studies that compared the clinical efficacy of at least 2 of the following 3 injection therapies: PRP, BMAC, and HA for knee OA. The search phrase used was knee AND osteoarthritis AND randomized AND ("platelet rich plasma" OR "bone marrow aspirate" OR "hyaluronic acid"). Patients were primarily assessed based on patient-reported outcome scores (PROs) including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) score.
RESULTS
Twenty-seven studies (all Level I) met inclusion criteria, including 1,042 patients undergoing intra-articular injection(s) with PRP (mean age 57.7 years, mean follow-up 13.5 months), 226 patients with BMAC (mean age 57.0 years, mean follow-up 17.5 months), and 1,128 patients with HA (mean age 59.0 years, mean follow-up 14.4 months). Nonnetwork meta-analyses demonstrated significantly better postinjection WOMAC (P < .001), VAS (P < .01), and Subjective IKDC scores (P < .001) in patients who received PRP compared with patients who received HA. Similarly, network meta-analyses demonstrated significantly better postinjection WOMAC (P < .001), VAS (P = .03), and Subjective IKDC (P < .001) scores in patients who received BMAC compared with patients who received HA. There were no significant differences in postinjection outcome scores when comparing PRP with BMAC.
CONCLUSIONS
Patients undergoing treatment for knee OA with PRP or BMAC can be expected to experience improved clinical outcomes when compared with patients who receive HA.
LEVEL OF EVIDENCE
Level I, meta-analysis of Level I studies.
Topics: Humans; Middle Aged; Hyaluronic Acid; Osteoarthritis, Knee; Bone Marrow; Treatment Outcome; Injections, Intra-Articular; Platelet-Rich Plasma
PubMed: 36913992
DOI: 10.1016/j.arthro.2023.03.001 -
The Australian and New Zealand Journal... Feb 2021Currently, pharmaceutical treatment options for autism spectrum disorder are limited. Brain glutaminergic dysregulation is observed in autism spectrum disorder.... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Currently, pharmaceutical treatment options for autism spectrum disorder are limited. Brain glutaminergic dysregulation is observed in autism spectrum disorder. -acetylcysteine, which can be converted to glutathione and subsequently release glutamate into the extracellular space, and thus reduce glutamatergic neurotransmission at synapses, is considered a potential drug for autism spectrum disorder treatment. Here, we analyzed the treatment effects of -acetylcysteine on autism spectrum disorder in randomized controlled trials.
STUDY DESIGN
Updated systematic review and meta-analysis.
DATA SOURCES
By systematically searching the PubMed, Embase and Cochrane Library, we obtained five randomized controlled trials.
STUDY SELECTION
Meta-analyses were performed to examine the improvement in autistic behaviors as measured by the Aberrant Behavior Checklist, Social Responsiveness Scale and Repetitive Behavior Scale-Revised, using mean difference with a 95% confidence interval and a random-effects model.
DATA SYNTHESIS
After 8-12 weeks of -acetylcysteine supplementation, the pooled result of four trials revealed an improvement in Aberrant Behavior Checklist total score (mean difference = 1.31, 95% confidence interval = [0.42, 2.20]). When one trial was excluded, the sensitivity test result was stronger (mean difference = 1.88, 95% confidence interval = [0.92, 2.83]). The pooled results of three trials revealed significant improvements in hyperactivity (mean difference = 4.80, 95% confidence interval = [1.20, 8.40]) and irritability (mean difference = 4.07, 95% confidence interval = [1.13, 7.04]). Regarding Social Responsiveness Scale, the pooled result of two trials showed significant improvement in social awareness after 8-12 weeks of -acetylcysteine supplementation (mean difference = 1.34, 95% confidence interval = [0.09, 2.59]). No differences were observed in the pooled results of two trials using Repetitive Behavior Scale, either in the total or the subscales.
CONCLUSION
We concluded that -acetylcysteine is safe and tolerable, reduces hyperactivity and irritability and enhances social awareness in children with autism spectrum disorder. However, further evidence should be sought before a general recommendation.
Topics: Acetylcysteine; Autism Spectrum Disorder; Child; Humans; Irritable Mood; Randomized Controlled Trials as Topic
PubMed: 32900213
DOI: 10.1177/0004867420952540 -
The Lancet. Diabetes & Endocrinology Oct 2019The benefits and risks of testosterone treatment for women with diminished sexual wellbeing remain controversial. We did a systematic review and meta-analysis to assess... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The benefits and risks of testosterone treatment for women with diminished sexual wellbeing remain controversial. We did a systematic review and meta-analysis to assess potential benefits and risks of testosterone for women.
METHODS
We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science for blinded, randomised controlled trials of testosterone treatment of at least 12 weeks' duration completed between Jan 1, 1990, and Dec 10, 2018. We also searched drug registration applications to the European Medicine Agency and the US Food and Drug Administration to identify any unpublished data. Primary outcomes were the effects of testosterone on sexual function, cardiometabolic variables, cognitive measures, and musculoskeletal health. This study is registered with the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42018104073.
FINDINGS
Our search strategy retrieved 46 reports of 36 randomised controlled trials comprising 8480 participants. Our meta-analysis showed that, compared with placebo or a comparator (eg, oestrogen, with or without progestogen), testosterone significantly increased sexual function, including satisfactory sexual event frequency (mean difference 0·85, 95% CI 0·52 to 1·18), sexual desire (standardised mean difference 0·36, 95% CI 0·22 to 0·50), pleasure (mean difference 6·86, 95% CI 5·19 to 8·52), arousal (standardised mean difference 0·28, 95% CI 0·21 to 0·35), orgasm (standardised mean difference 0·25, 95% CI 0·18 to 0·32), responsiveness (standardised mean difference 0·28, 95% CI 0·21 to 0·35), and self-image (mean difference 5·64, 95% CI 4·03 to 7·26), and reduced sexual concerns (mean difference 8·99, 95% CI 6·90 to 11·08) and distress (standardised mean difference -0·27, 95% CI -0·36 to -0·17) in postmenopausal women. A significant rise in the amount of LDL-cholesterol, and reductions in the amounts of total cholesterol, HDL-cholesterol, and triglycerides, were seen with testosterone administered orally, but not when administered non-orally (eg, by transdermal patch or cream). An overall increase in weight was recorded with testosterone treatment. No effects of testosterone were reported for body composition, musculoskeletal variables, or cognitive measures, although the number of women who contributed data for these outcomes was small. Testosterone was associated with a significantly greater likelihood of reporting acne and hair growth, but no serious adverse events were recorded.
INTERPRETATION
Testosterone is effective for postmenopausal women with low sexual desire causing distress, with administration via non-oral routes (eg, transdermal application) preferred because of a neutral lipid profile. The effects of testosterone on individual wellbeing and musculoskeletal and cognitive health, as well as long-term safety, warrant further investigation.
FUNDING
Australian National Health and Medical Research Council.
Topics: Androgens; Female; Hormone Replacement Therapy; Humans; Libido; Sexual Dysfunction, Physiological; Testosterone; Treatment Outcome; Women's Health
PubMed: 31353194
DOI: 10.1016/S2213-8587(19)30189-5 -
Ageing Research Reviews Jul 2023The impact of oral nutritional supplements (ONS) on patients with complications (disease related morbidity) requires further exploration. This systematic review included... (Meta-Analysis)
Meta-Analysis Review
The impact of oral nutritional supplements (ONS) on patients with complications (disease related morbidity) requires further exploration. This systematic review included 44 randomised controlled trials (RCT) (29 RCT surgical, 15 RCT medical patients) examining the effect of ONS in community settings on the incidence of complications (n = 716, mean age 67 years, range 35-87). ONS (mean intake 588 kcal/day, range 125-1750; protein 22 g/day, range 0-54; mean energy from protein 22 %, range 0-54) were prescribed for a mean 74 days, range 5-365. Most RCT (77 %) reported fewer complications in the ONS group versus control. Meta-analysis (39 RCT) showed ONS consumption reduced complications including infections, pressure ulcers, wound and fracture healing (OR 0.68, 95 % CI 0.59,0.79; p<0.001). Results showed reductions when ONS were used in hospital and community settings (OR 0.72, 95 % CI 0.59,0.87; p = 0.001) or just in the community (OR 0.65, 95 % CI 0.52, 0.80; p<0.001). Reductions in complications were only seen with high ONS adherence ≥ 80 % (OR 0.63, 95 % CI 0.48,0.83; p = 0.001) and ready-to-drink ONS (OR 0.69, 95 % CI 0.60,0.81; p<0.001). This systematic review and meta-analysis show community-based use of ONS in addition to the diet substantially reduces the incidence of complications. The diversity of ONS, patient populations and complication outcomes within the trials included in this review mean further research is warranted.
Topics: Humans; Aged; Aged, 80 and over; Dietary Supplements; Malnutrition
PubMed: 37182743
DOI: 10.1016/j.arr.2023.101953 -
Revista Espanola de Salud Publica Oct 2021Depression is a disease prevalent in most older people and is negatively associated with suicidal ideation and behaviour in the elderly. The objective of this systematic... (Review)
Review
BACKGROUND
Depression is a disease prevalent in most older people and is negatively associated with suicidal ideation and behaviour in the elderly. The objective of this systematic review was to study the relationship between suicidal behaviour and the associated risk factors that lead older people to commit it.
METHODS
We searched systematically in the PubMed, Web of Science, SciELO and CUIDEN database, in addition, we used a search engine, Google Scholar, including studies when they were observational, with population of 60 years or more, whose patients had made any suicide attempt and instead were excluded when the participants were children or adolescents, reported cases of homicide or only reported the methods used in the suicide. The search was not delimited based on filters or time periods. The data is presented based on Odds Ratio, Relative Risk and percentage (%).
RESULTS
Eighteen studies were included in this systematic review. Various factors associated with the appearance of suicidal behaviour in the elderly were reported, the following are the most relevant: serious mental disorders (mean OR/RR value of 157.80); depression (mean OR/RR value of 16.53); and previous suicide attempts (average OR/RR value of 12.33).
CONCLUSIONS
Pathological, sociodemographic and psychosocial factors related to the ideation and appearance of suicidal behaviour in the elderly have been differentiated.
Topics: Adolescent; Aged; Child; Humans; Odds Ratio; Risk Factors; Spain; Suicidal Ideation; Suicide, Attempted
PubMed: 34620818
DOI: No ID Found -
International Journal of Nursing Studies Sep 2022Cardiovascular disease has risen sharply and causes more premature deaths than cancer, while it represents a major economic burden for healthcare systems and impacts... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cardiovascular disease has risen sharply and causes more premature deaths than cancer, while it represents a major economic burden for healthcare systems and impacts patients' quality of life negatively. Virtual reality has captured the attention of researchers in the field of cardiac rehabilitation. However, the efficacy of virtual reality among individuals undergoing cardiac rehabilitation remains inconclusive.
OBJECTIVE
To appraise research evidence on the effects of virtual reality for individuals undergoing cardiac rehabilitation.
DESIGN
Systematic review and meta-analysis.
METHODS
A systematic search of publications was conducted using Pubmed, Embase, Web of science, Cumulative Index to Nursing and Allied Health Literature database (CINAHL), Cochrane Central Register of Controlled trials and Physiotherapy Evidence Database (PEDro) from inception to 15 May 2022, without language restriction. The Cochrane Risk of Bias Tool was used to examine the methodological quality of the included randomized controlled studies. When feasible, a meta-analysis was performed to calculate the pooled effects using Review Manager (Version 5.4). Otherwise, narrative summaries were performed. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of the evidence.
RESULTS
A total of ten studies were included. Virtual reality probably increases exercise capacity for individuals undergoing cardiac rehabilitation (the pooled mean difference 49.55, 95% confidence interval 30.59 ~ 68.52, P < 0.00001, moderate-certainty evidence) and might result in a reduction in emotional tension (mean difference -6.43, 95% confidence interval -9.02 ~ -3.84, P < 0.00001, low-certainty evidence) and intrapsychic stress (mean difference -4.25, 95% confidence interval -6.83 to -1.67, P = 0.001, low-certainty evidence). It also seemed to have a positive effect on quality of life, although meta-analysis could not be conducted to pool the results. Virtual reality might reduce depression (standardised mean difference -0.48, 95% confidence interval -0.84 ~ -0.12, P = 0.009,very low- certainty evidence), but the evidence was uncertain, with similar results of anxiety, general level of stress, external stress, total cholesterol, and low-density lipoprotein. The evidence was uncertain about the effect of virtual reality on high-density lipoprotein (mean difference -1.79, 95% confidence interval -8.96 ~ 5.38, P = 0.62, very low-certainty evidence), with similar results of triglycerides and BMI.
CONCLUSIONS
Individuals undergoing cardiac rehabilitation may benefit from virtual reality since it can improve exercise capacity and psychological outcomes. More large, and well-designed studies with tailored virtual reality intervention are warranted to confirm the effects of virtual reality on individuals undergoing cardiac rehabilitation.
TWEETABLE ABSTRACT
Virtual reality may benefit individuals undergoing cardiac rehabilitation since it can improve exercise capacity and psychological outcomes.
Topics: Anxiety; Cardiac Rehabilitation; Humans; Quality of Life; Randomized Controlled Trials as Topic; Virtual Reality
PubMed: 35870329
DOI: 10.1016/j.ijnurstu.2022.104323 -
Menopause (New York, N.Y.) Jan 2024The neurokinin 3 receptor antagonist fezolinetant 45 mg/d significantly reduced frequency/severity of moderate to severe vasomotor symptoms (VMS) of menopause compared... (Meta-Analysis)
Meta-Analysis
Systematic review and network meta-analysis comparing the efficacy of fezolinetant with hormone and nonhormone therapies for treatment of vasomotor symptoms due to menopause.
IMPORTANCE
The neurokinin 3 receptor antagonist fezolinetant 45 mg/d significantly reduced frequency/severity of moderate to severe vasomotor symptoms (VMS) of menopause compared with placebo in two phase 3 randomized controlled trials. Its efficacy relative to available therapies is unknown.
OBJECTIVE
We conducted a systematic review and Bayesian network meta-analysis to compare efficacy with fezolinetant 45 mg and hormone therapy (HT) and non-HT for VMS in postmenopausal women.
EVIDENCE REVIEW
Using OvidSP, we systematically searched multiple databases for phase 3 or 4 randomized controlled trials in postmenopausal women with ≥7 moderate to severe VMS per day or ≥50 VMS per week published/presented in English through June 25, 2021. Mean change in frequency and severity of moderate to severe VMS from baseline to week 12 and proportion of women with ≥75% reduction in VMS frequency at week 12 were assessed using fixed-effect models.
FINDINGS
The network meta-analysis included data from the pooled phase 3 fezolinetant trials plus 23 comparator publications across the outcomes analyzed (frequency, 19 [34 regimens]; severity, 6 [7 regimens]; ≥75% response, 9 [15 regimens]). Changes in VMS frequency did not differ significantly between fezolinetant 45 mg and any of the 27 HT regimens studied. Fezolinetant 45 mg reduced the frequency of moderate to severe VMS events per day significantly more than all non-HTs evaluated: paroxetine 7.5 mg (mean difference [95% credible interval {CrI}], 1.66 [0.63-2.71]), desvenlafaxine 50 to 200 mg (mean differences [95% CrI], 1.12 [0.10-2.13] to 2.16 [0.90-3.40]), and gabapentin ER 1800 mg (mean difference [95% CrI], 1.63 [0.48-2.81]), and significantly more than placebo (mean difference, 2.78 [95% CrI], 1.93-3.62]). Tibolone 2.5 mg (the only HT regimen evaluable for severity) significantly reduced VMS severity compared with fezolinetant 45 mg. Fezolinetant 45 mg significantly reduced VMS severity compared with desvenlafaxine 50 mg and placebo and did not differ significantly from higher desvenlafaxine doses or gabapentin ER 1800 mg. For ≥75% responder rates, fezolinetant 45 mg was less effective than tibolone 2.5 mg (not available in the United States) and conjugated estrogens 0.625 mg/bazedoxifene 20 mg (available only as 0.45 mg/20 mg in the United States), did not differ significantly from other non-HT regimens studied and was superior to desvenlafaxine 50 mg and placebo.
CONCLUSIONS
The only HT regimens that showed significantly greater efficacy than fezolinetant 45 mg on any of the outcomes analyzed are not available in the United States. Fezolinetant 45 mg once daily was statistically significantly more effective than other non-HTs in reducing the frequency of moderate to severe VMS.
RELEVANCE
These findings may inform decision making with regard to the individualized management of bothersome VMS due to menopause.
Topics: Female; Humans; Hot Flashes; Desvenlafaxine Succinate; Network Meta-Analysis; Gabapentin; Bayes Theorem; Menopause; Estrogens, Conjugated (USP)
PubMed: 38016166
DOI: 10.1097/GME.0000000000002281 -
JAMA Cardiology Jun 2023Low-dose combination (LDC) antihypertensives consisting of 3 or 4 blood pressure (BP)-lowering drugs have emerged as a potentially important therapy for the initial... (Meta-Analysis)
Meta-Analysis
Efficacy and Safety of Low-Dose Triple and Quadruple Combination Pills vs Monotherapy, Usual Care, or Placebo for the Initial Management of Hypertension: A Systematic Review and Meta-analysis.
IMPORTANCE
Low-dose combination (LDC) antihypertensives consisting of 3 or 4 blood pressure (BP)-lowering drugs have emerged as a potentially important therapy for the initial management of hypertension.
OBJECTIVE
To assess the efficacy and safety of LDC therapies for the management of hypertension.
DATA SOURCES
PubMed and Medline were searched from date of inception until September 2022.
STUDY SELECTION
Randomized clinical trials comparing LDC consisting of 3 or 4 BP-lowering drugs compared to either monotherapy, usual care, or placebo.
DATA EXTRACTION AND SYNTHESIS
Data were extracted by 2 independent authors and synthesized using both random and fixed-effects models using risk ratios (RR) for binary outcomes and mean differences for continuous outcomes.
MAIN OUTCOMES AND MEASURES
The primary outcome was mean reduction in systolic BP (SBP) between LDC and monotherapy, usual care, or placebo. Other outcomes of interest included the proportion of patients achieving BP less than 140/90 mm Hg, rates of adverse effects, and treatment withdrawal.
RESULTS
Seven trials with a total of 1918 patients (mean [mean range] age, 59 [50-70] years; 739 [38%] female) were included. Four trials involved triple-component LDC and 3 involved quadruple-component LDC. At 4 to 12 weeks follow-up, LDC was associated with a greater mean reduction in SBP than initial monotherapy or usual care (mean reduction, 7.4 mm Hg; 95% CI, 4.3-10.5) and placebo (mean reduction, 18.0 mm Hg; 95% CI, 15.1-20.8). LDC was associated with a higher proportion of participants achieving BP less than 140/90 mm Hg at 4 to 12 weeks compared to both monotherapy or usual care (66% vs 46%; RR, 1.40; 95% CI, 1.27-1.52) and placebo (54% vs 18%; RR, 3.03; 95% CI, 1.93-4.77). There was no significant heterogeneity between trials enrolling patients with and without baseline BP-lowering therapy. Results from 2 trials indicated LDC remained superior to monotherapy or usual care at 6 to 12 months. LDC was associated with more dizziness (14% vs 11%; RR 1.28, 95% CI 1.00-1.63) but no other adverse effects nor treatment withdrawal.
CONCLUSIONS AND RELEVANCE
The findings in the study showed that LDCs with 3 or 4 antihypertensives were an effective and well-tolerated BP-lowering treatment option for the initial or early management of hypertension.
Topics: Humans; Female; Middle Aged; Male; Antihypertensive Agents; Hypertension; Blood Pressure
PubMed: 37099314
DOI: 10.1001/jamacardio.2023.0720