國家衛生研究院 NHRI:Item 3990099045/9364

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Title:	Effects of antihypertensive therapies on primary and secondary prevention of stroke: Systematic review and network meta-analysis
Authors:	Cheng, HM;Wang, WT;Chiang, CE;Sung, SS;You, LK;Chuang, SY;Chen, CH
Contributors:	Division of Health Services and Preventive Medicine
Abstract:	Background: Hypertension is the most important risk factor for stroke and stroke recurrence. However, the preferred antihypertensive therapy for these patients has yet to be determined. Methods: We performed a systematic review, network meta-analysis, and metaregression of randomized controlled trials that investigated the effect of antihypertensive therapies on primary prevention of stroke or secondary prevention for previous stroke patients of any vascular event. Trials were identiﬁed from searches of published hypertension guidelines, electronic databases, and clinical trial registries. Results: For primary prevention (39 trials, 283529 patients), all antihypertensive agents, except alpha-blocker, outperformed placebo in preventing any stroke events. By using probability ranking for mixed treatment comparisons, angiotension receptor blocker may be the most preferred agent for primary prevention of stroke. For secondary prevention (10 trials, 40496 patients), only diuretics signiﬁcantly outperformed placebo for preventing any adverse vascular events, and should be the class of choice for patients with previous stroke. Moreover, for primary prevention trials, the meta-regression analysis showed that 1 mmHg decrease of BP was associated with an 0.12% absolute risk reduction of (95% conﬁdence interval 0.061–0.170; p=0.00012) for any stroke. Conclusions: Evidence from randomized controlled trials supports the use of antihypertensive agents in lowering blood pressure for the primary prevention of stroke and secondary prevention of vascular events in patients with previous stroke. Although angiotension receptor antagonist and diuretics may be the most preferred strategies for primary and secondary prevention, repectively, the ﬁnal achieved BP may be the key element in the effective risk reduction for primary prevention of stroke.
Date:	2015-08
Relation:	European Heart Journal. 2015 Aug;36(Suppl.1):879.
Link to:	http://dx.doi.org/10.1093/eurheartj/ehv401
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0195-668X&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000361205106107
Appears in Collections:	[Shao-Yuan Chuang] Conference Papers/Meeting Abstract

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