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TOPLINE:

In short-term trials involving medications for lowering blood pressure (BP), regimens containing an angiotensin receptor blocker (ARB) were associated with a reduced risk for discontinuation of treatment due to adverse events, while calcium channel blockers and other drug combinations were associated with a higher risk for discontinuation.

METHODOLOGY:

• Researchers conducted a systematic review and network meta-analysis to compare the short-term adverse effects and risk for discontinuation of treatment across major BP-lowering drug classes and combinations.
• They searched three literature databases from inception through December 2024 and reviewed prior reviews and FDA drug approvals.
• The included studies were double-blind randomized clinical trials in adults that assessed the effects of angiotensin-converting enzyme (ACE) inhibitors, ARBs, beta-blockers, calcium channel blockers, diuretics, or their combinations, with treatment and follow-up lasting 4-26 weeks.
• The primary outcome was the discontinuation of treatment due to adverse events. Secondary outcomes included the incidence of dizziness, headache, cough, and edema.

TAKEAWAY:

• The analysis included 716 trials with 159,362 participants (mean age, 54.6 years; 44% female). The mean duration of treatment was 8.6 weeks.
• The risk for the discontinuation of treatment due to adverse events was significantly lower with ARB monotherapy (risk difference [RD], -0.8%; 95% credible interval [CrI], -1.3% to -0.4%) and with the combination of an ARB and calcium channel blocker (RD, -1.2%; 95% CrI, -1.8% to -0.6%) than with placebo.
• Monotherapy with calcium channel blockers was associated with a significantly increased risk for the discontinuation of treatment due to adverse events (RD, 1.2%; 95% CrI, 0.6%-2.0%), as were regimens with an ACE inhibitor and calcium channel blocker (RD, 1.1%; 95% CrI, 0.2%-2.4%) and a beta-blocker and thiazide diuretic (RD, 1.7%; 95% CrI, 0.1%-4.3%).
• All BP-lowering regimens were associated with higher risk for dizziness than placebo, whereas most regimens were linked to a lower risk for headaches. Based on trial-level data, an ARB combined with a calcium channel blocker ranked as the best-tolerated regimen overall.

IN PRACTICE:

“Results from the study by Wang et al can help inform clinicians’ selection of antihypertensive therapies for patients initiating medications for hypertension, particularly when comorbidities, such as the presence of diabetes with microvascular disease, do not warrant a specific therapy,” Mary M. McDermott, MD, and Stephen D. Persell, MD, MPH, wrote in an accompanying editorial.

“The work by Wang et al serves as a reminder to ask patients about adverse effects that may be associated with antihypertensive therapy particularly because adverse effects can impair adherence, which in turn may reduce the ability of the antihypertensive medications to prevent cardiovascular events,” they added.

SOURCE:

The study was led by Nelson Wang, PhD, University of New South Wales, Sydney, Australia. It was published online on May 28 in JAMA.

LIMITATIONS:

Assumptions of network meta-analysis such as population heterogeneity, transitivity, and model consistency existed. The study focused on short-term trials and excluded studies longer than 6 months. Most participants were middle-aged adults with hypertension and few comorbidities.

DISCLOSURES:

The study received funding from a program grant from the National Health and Medical Research Council (NHMRC). Several authors reported receiving grants, fellowships, travel support, or personal fees from industry and research organizations including NHMRC. One author reported working part-time as chief medical officer of George Medicines and holding related patents. Another author reported having institutional ties related to investment in fixed-dose combination products.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.