Background
Methods
Selection criteria of international evidence-based medicine lists
Literature search strategy
Literature inclusion criteria
Literature exclusion criteria
Literature quality assessment
Quality assessment for systematic review and meta-analysis
Quality assessment for RCT
Analysis strategy
Statistical analysis
Results
General information
Evidence from the three international evidence-based clinical guidelines
Dosage form | JNC 8 | NICE 2011 | WHO EML 2017 | Frequency of inclusion | |
---|---|---|---|---|---|
Calcium antagonist | |||||
Class A | |||||
Amlodipine | oral release dosage form | √ | √ | √ | 3 |
Nimodipine | oral release dosage form | – | – | – | 0 |
Nitrendipine | oral release dosage form | – | – | – | 0 |
Nifedipine | oral release dosage form | – | √ | √ | 2 |
Diltiazem | oral release dosage form | – | √ | √ | 2 |
Verapamil | oral release dosage form | – | √ | √ | 2 |
Verapamil | injection | – | – | √ | 1 |
Class B | |||||
L - nmda amlodipine | oral release dosage form | – | – | – | 0 |
Amlodipine atorvastatin calcium | oral release dosage form | – | – | – | 0 |
Benidipine | oral release dosage form | – | – | – | 0 |
Felodipine | oral release dosage form, controlled release dosage form | – | √ | – | 1 |
Felodipine II | controlled release dosage form | – | √ | – | 1 |
Lacidipine | oral release dosage form | – | √ | – | 1 |
Lercanidipine | oral release dosage form | – | √ | – | 1 |
Nicardipine | oral release dosage form, controlled release dosage form | – | – | – | 0 |
Nicardipine | injection | – | – | – | 0 |
Nimodipine | injection | – | – | – | 0 |
Nitrendipine and Atenolol | oral release dosage form | – | – | – | 0 |
Cilnidipine | oral release dosage form | – | – | – | 0 |
Nifedipine (I,II,III) | controlled release dosage form | – | √ | √ | 2 |
Levamlodipine besylate tablets | oral release dosage form | – | √ | – | 1 |
Diltiazem | injection | – | – | – | 0 |
Diltiazem (II) | controlled release dosage form | – | √ | √ | 2 |
Verapamil | controlled release dosage form | – | √ | √ | 2 |
β blockers | |||||
Class A | |||||
Propranolol | oral release dosage form | – | √ | √ | 2 |
Atenolol | oral release dosage form | √ | √ | – | 2 |
Bisoprolol | oral release dosage form | – | √ | √ | 2 |
Metoprolol | oral release dosage form | √ | √ | – | 2 |
Metoprolol | injection | – | – | – | 0 |
Class B | |||||
Propranolol | Sustained or controlled release dosage form | – | √ | √ | 2 |
Propranolol | injection | – | – | – | 0 |
Sotalol | oral release dosage form | – | √ | – | 1 |
Sotalol | injection | – | – | – | 0 |
Esmolol | injection | – | – | – | 0 |
Metoprolol | controlled release dosage form | √ | √ | – | 2 |
Arotinolol | oral release dosage form | – | – | – | 0 |
Carvedilol | oral release dosage form | – | – | – | 0 |
Labetalol | oral release dosage form | – | – | – | 0 |
diuretics | |||||
Class A | |||||
Hydrochlorthiazide | oral release dosage form | √ | √ | √ | 3 |
Indapamide | oral release dosage form, controlled release dosage form | √ | √ | – | 2 |
Furosemide | oral release dosage form | – | – | √ | 1 |
Furosemide | injection | – | – | √ | 1 |
Triamterene | oral release dosage form | – | – | – | 0 |
Spironolactone | oral release dosage form | – | √ | √ | 2 |
Class B | |||||
Bumetanide | oral release dosage form | – | – | – | 0 |
Bumetanide | injection | – | – | – | 0 |
Torasemide | oral release dosage form | – | – | – | 0 |
Torasemide | injection | – | – | – | 0 |
Amiloride | oral release dosage form | – | √ | √ | 2 |
ACEIs | |||||
Class A | |||||
Captopril | oral release dosage form | √ | √ | – | 2 |
Enalapril | oral release dosage form | √ | √ | √ | 3 |
Class B | |||||
Benazepril | oral release dosage form | – | – | – | 0 |
Fosinopril | oral release dosage form | – | – | – | 0 |
Lisinopril | oral release dosage form | √ | √ | – | 2 |
Ramipril | oral release dosage form | – | √ | – | 1 |
Imidapril | oral release dosage form | – | – | – | 0 |
Perindopril | oral release dosage form | – | √ | – | 1 |
Cilazapril | oral release dosage form | – | – | – | 0 |
Amlodipine benapril I (II) | oral release dosage form | – | – | – | 0 |
Benapril hydrochlorothiazide | oral release dosage form | – | – | – | 0 |
compound captopril | oral release dosage form | – | – | – | 0 |
Lynopli hydrochlorothiazide | oral release dosage form | – | – | – | 0 |
Enalpril hydrochlorothiazide | oral release dosage form | – | – | – | 0 |
Enopril folic acid | oral release dosage form | – | – | – | 0 |
Angiotensin II receptor antagonist | |||||
Class B | |||||
Olmesartan Medoxomil | oral release dosage form | – | – | – | 0 |
Irbesartan | oral release dosage form, controlled release dosage form | √ | √ | – | 2 |
Candesartan | oral release dosage form | √ | √ | – | 2 |
Losartan | oral release dosage form | √ | √ | √ | 3 |
Telmisartan | oral release dosage form | √ | √ | – | 2 |
Valsartan | oral release dosage form | √ | √ | – | 2 |
Omethane hydrochlorothiazide | oral release dosage form | – | – | – | 0 |
irbesartan hydrochlorothiazide | oral release dosage form | – | – | – | 0 |
chlorothiazide | oral release dosage form | – | – | – | 0 |
Timisaltan hydrochlorothiazide | oral release dosage form | – | – | – | 0 |
Valsartan chlordipine I (II) | oral release dosage form | – | – | – | 0 |
Valsartan hydrochlorothiazide | oral release dosage form | – | – | – | 0 |
vasodilators | |||||
Class A | |||||
Phentolamine | injection | – | – | – | 0 |
Sodium nitroprusside | injection | – | – | √ | 1 |
Class B | |||||
Phenoxybenzamine | oral release dosage form | – | – | – | 0 |
Phenoxybenzamine | injection | – | – | – | 0 |
Hydralazine | oral release dosage form | – | – | √ | 1 |
Hydralazine | injection | – | – | √ | 1 |
Minoxidil | oral release dosage form | – | – | – | 0 |
Others | |||||
Class A | |||||
Reserpine | injection | – | – | – | 0 |
Prazosin | oral release dosage form | – | √ | – | 1 |
Compound reserpine | oral release dosage form | – | – | – | 0 |
Compound reserpine ammonia benzene pteridine | oral release dosage form | – | – | – | 0 |
Class B | |||||
Dibazole | oral release dosage form | – | – | – | 0 |
Methyldopa | oral release dosage form | – | √ | √ | 2 |
Clonidine | oral release dosage form | – | – | – | 0 |
Clonidine | Patch | – | – | – | 0 |
Reserpine | oral release dosage form | – | – | – | 0 |
Ligustrazine | Injection | – | – | – | 0 |
Doxazosin | oral release dosage form, controlled release dosage form | – | √ | – | 1 |
Naftopidil | oral release dosage form | – | – | – | 0 |
Urapidil | oral release dosage form, controlled release dosage form | – | – | – | 0 |
Urapidil | injection | – | – | – | 0 |
Evidence from published literature with high evidence grade
Evidence from systematic review and meta-analysis
Dosage form | Meta-analysis /Systematic review (First author, year) | AMSTAR score | PRISMA score | Research conclusions | Sound support for effectiveness (Y / N) | |
---|---|---|---|---|---|---|
Calcium antagonist | ||||||
Class A | ||||||
Nimodipine | oral release dosage form | Chen Q, 2014 [27] | 8.5 | 25 | For patients with HICH, nimodipine combined with edaravone has significant clinical efficacy in the treatment of hypertensive cerebral hemorrhage, and can improve the functional rehabilitation of the nerves and effectively reduce the volumes of intracranial hematoma and peripheral edema. | Y |
Nitrendipine | oral release dosage form | Du X, 2014 [32] | 8 | 21 | In lowering blood pressure, Amlodipine is better than Nitrendipine in the cost and effect. | N |
Class B | ||||||
Levamlodipine besylate | oral release dosage form | Zhao Z, 2015 [26] | 8.5 | 24 | Levamlodipine is more effective and safer than amlodipine in treatment of mild to moderate hypertension than, which is thus worthy of clinical application. | Y |
Felodipine | oral release dosage form, controlled release dosage form | Zhang T, 2013 [33] | 8 | 21 | In the treatment of Chinese patients with hypertension, amlodipine both in reducing systolic or diastolic pressure were better than felodipine, no statistical significance on both heart rate and adverse drug reaction differences. | N |
Felodipine II | controlled release dosage form | Zhang T, 2013 [33] | 8 | 21 | In the treatment of Chinese patients with hypertension, amlodipine both in reducing systolic or diastolic pressure were better than felodipine, no statistical significance on both heart rate and adverse drug reaction differences. | N |
Lercanidipine | oral release dosage form | Ran Y, 2015 [20] | 8.5 | 23 | Based on the current evidence, the safety and compliance of lercanidipine is better than amlodipine in the treatment of mild to moderate hypertension. | Y |
Nicardipine | injection | Jiang C, 2013 [19] | 8.5 | 24.5 | Nicardipine was safe and effective in the treatment of hypertensive emergency. | Y |
Lacidipine | oral release dosage form | Hua Q, 2014 [18] | 9.5 | 23 | Lacidipine has been similar to amlodipine in the treatment of essential hypertension with less adverse drug reaction. | Y |
Cilnidipine | oral release dosage form | Li S, 2012 [16] | 9 | 22.5 | Cilnidipine has the similar efficacy and safety compared with control group in treating essential hypertension. | Y |
β-blockers | ||||||
Class B | ||||||
Arotinolol | oral release dosage form | Du B, 2009 [21] | 8.5 | 21.5 | In treating essential hypertension, there is no significant difference in efficacy and safety between Arotinolol and control group, such as Cilnidipine, felodipine and Imidapril. | Y |
Labetalol | oral release dosage form | Magee LA, 2015 [29] | 9 | 24 | Labetalol is a reasonable choice for treatment of severe or non-severe hypertension in pregnancy | Y |
Carvedilol | oral release dosage form | Chen S, 2015 [13] | 9 | 24 | Carvedilol has a greater portal hypertensive effect than propranolol. Further comparative trials of the two drugs are required to identify the effect of MAP reduction. | Y |
Esmolol | injection | Garnockjones KP, 2012 [31] | 10 | 25 | Definitive conclusions on the efficacy of esmolol are difficult to reach, as most trials investigating esmolol have limitations such as small patient populations, and few studies investigate the same parameters. | N |
ACEIs | ||||||
Class B | ||||||
Perindopril | oral release dosage form | Gasowski J, 2010 [12] | 8.5 | 24 | Perindopril is an effective antihypertensive medication. Seems not to be adversely affected by the clinical profile of the patient. | Y |
Benazepril | oral release dosage form | Zhao S, 2015 [22] | 7.5 | 22 | Benazepril can more effectively lower the blood pressure of patients with primary hypertension than captopril. | Y |
Fosinopril | oral release dosage form | Zeng X, 2014 [11] | 8.5 | 23.5 | The curative effect of fosinopril is almost the same as calcium antagonists in the treatment of mild to moderate essential hypertension, but superior to other types of antihypertensive drugs and shows good safety. | Y |
Enopril folic acid | oral release dosage form | Zhang Y, 2015 [23] | 7.5 | 22 | Enopril folic acid showed better efficacy in lowering blood pressure and preventing cardiovascular accident than Enopril. | Y |
Vasodilators | ||||||
Class A | ||||||
Sodium nitroprusside | injection | Dong W, 2012 [17] | 9.5 | 22 | Sodium nitroprusside is effective for the treatment of hypertensive emergency, while the ADRs are acceptable. | Y |
Class B | ||||||
Hydralazine | oral release dosage form | Kandler M R, 2010 [34] | 11 | 27 | Hydralazine may reduce blood pressure when compared to placebo in patients with primary hypertension, however this data is based on before and after studies, not RCTs. Furthermore, its effect on clinical outcomes remains uncertain. | N |
Angiotensin II receptor antagonist | ||||||
Class B | ||||||
Irbesartan /Hydrochlorothiazide | oral release dosage form | Wu H, 2011 [24] | 8.5 | 23 | Irbesartan/hydrochlorothiazide combination therapy is more effective than control group in treating essential hypertension and there is no significant difference in safety. | Y |
Valsartan /Hydrochlorothiazide | oral release dosage form | Jin J, 2013 [25] | 8 | 21 | In the treatment of primary hypertension, Valsartan /Hydrochlorothiazide combination has better anti-hypertension efficacy with less adverse drug reaction. | Y |
Others | ||||||
Class A | ||||||
Compound reserpine | oral release dosage form | Hu L, 2012 [30] | 9 | 25.5 | Based on current research evidence, Compound reserpine tablets are safe and effective. | Y |
Compound reserpine ammonia benzene pteridine | oral release dosage form | Wu Y, 2009 [28] | 9 | 23 | Compound reserpine ammonia benzene pteridine appears to have the same effect as other anti-hypertensive drugs without having more adverse events. | Y |
Class B | ||||||
Doxazosin | oral release dosage form | Ke Z, 2015 [14] | 8.5 | 24 | Doxazosin has affirmed effect on mild to moderate essential hypertension, with little side effect, good patient tolerance, especially for hypertension patients with benign prostatic hyperplasia. | Y |
Urapidil | injection | Zhou X, 2016 [15] | 7.5 | 21.5 | Urapidil and conventional vasedilator like Nitroglycerin are effective to heart failure with hypertension. For lowering blood pressure, their efficacy are equal, but for reducing patients BNP and heart rate, Urapidil is better than the other. | Y |
Reserpine | oral release dosage form | Shamon S D, 2009 [35] | 9 | 25 | Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs. However, we could not make definite conclusions regarding the dose-response pattern because of the small number of included trials. More RCTs are needed to assess the effects of reserpine on blood pressure and to determine the dose-related safety profile before the role of this drug in the treatment of primary hypertension can be established. | N |
Evidence from RCT
Dosage form | RCT (First author, year) | JADAD score | Research conclusions | Sound support for effectiveness (Y / N) | |
---|---|---|---|---|---|
ACEIs | |||||
Class B | |||||
Amlodipine benapril | oral release dosage form | Cao J, 2012 [36] | 2 | Amlodipine benapril can achieve better antihypertensive effect and reduce adverse reactions, which is worthy of clinical promotion. | N |
Enalpril hydrochlorothiazide | oral release dosage form | Wang X, 2006 [48] | 4 | The efficacy of combination of enalapril hydrochlorothiazide is better than single use of enalapril in the treatment of mild and moderate primary hypertension. Combination of enalapril hydrochlorothiazide has the same safety and toleration as enalapril. | Y |
Imidapril | oral release dosage form | Jiang X, 2005 [46] | 4 | Imidapril and Benapril are both similarly effective in the reduction of the peripheral blood pressure and the central blood pressure. | Y |
Ramipril | oral release dosage form | Tao B, 2006 [44] | 4 | The combination of irbesartan with felodipine or ramipril showed synergist antihypertensive effects. Moreover, the combination of irbesartan with felodipine was superior to combination of irbesartan with ramipril. | Y |
Rokoss M J, 2005 [45] | 5 | Beneficial effects of ramipril are observed in the treatment of hypertension and congestive heart failure, prevention of cardiovascular events in high-risk patients, prevention of congestive heart failure, diabetes and other vascular events | Y | ||
Cilazapril | oral release dosage form | Schiffrin EL, 2008 [49] | 4 | These results may indicate that treatment with cilazapril and perhaps with other angiotensin-I- converting enzyme inhibitors as well may improve the clinical outcome in hypertension by inducing a regression of abnormal resistance vessel structure and function. | Y |
β-blockers | |||||
Class A | |||||
Metoprolol | injection | Lu N, 2006 [37] | 2 | Metoprolol is effective and safe for patients with unstable angina pectoris. It may significantly lower the risk of refractory angina pectoris. | N |
Class B | |||||
Propranolol | injection | Jiang X, 2001 [39] | 2 | Combination of propranolol with prazosin caused a signincantly greater reduction in the portal pressure on the third month and the reduction in H/L and responding rate were greater in the treatment group than in the control group in patients with a previous bleeding episode. | N |
Zuo W, 2007 [38] | 3 | Propranolol, ISMN and spironolactone in combination can effectively prevent the occurrence of hemorrhage in cirrhotic patients with esophageal varices | Y | ||
Calcium antagonist | |||||
Class B | |||||
Diltiazem | injection | Collaborative Group of Diltiazem, 2005 [47] | 4 | Intravenous diltiazem therapy is effective and safe for patients with unstable angina pectoris. It may significantly lower the risk of refractory angina pectoris compared with intravenous nitroglycerin. | Y |
Diuretics | |||||
Class A | |||||
Furosemide | injection | Huang G, 2008 [40] | 3 | The use of 125 ml 20% mannitol each time plus 20 mg furosemide is more reasonable than other combinations. Meanwhile, semis mannitol combined with moderate or large dose of albumin has certain advantages too. | Y |
Class B | |||||
Torasemide | injection | Zheng W, 2008 [41] | 3 | Torasemide injection is an effective and safe drug for the treatment of congestive heart failure with edema. | Y |
Angiotensin II receptor antagonist | |||||
Class B | |||||
Olmesartan Medoxomil | oral release dosage form | Liao Y, 2014 [43] | 3 | Compared with enalapril, Olmesartan Medoxomil has more significant inhibition and reversal effects of left ventricular remodeling in treatment of the morning surge of hypertension. | Y |
Others | |||||
Class B | |||||
Naftopidil | oral release dosage form | Lu Q, 2000 [42] | 3 | The efficacy of Naftopidil in controlling the blood pressure is as efficient as that of Terazosin and both drugs are well tolerated by the patients. | Y |
Overall situation of evidence support
Sound evidence support | Subtotal | Insufficient evidence support | Subtotal | |||||
---|---|---|---|---|---|---|---|---|
Support from international evidence-based drug list | Support from systematic review or meta-analysis | Support from RCT | Reported by RCT with poor quality | No evidence involved | No definite conclusion in systematic review or meta-analysis | |||
Calcium antagonist | 7 (29.2%) | 6 (25.0%) | 1 (4.2%) | 14 (58.3%) | 0 (0.0%) | 7 (29.2%) | 3(12.5%) | 10 (41.7%) |
β blockers | 6 (42.9%) | 3 (21.4%) | 1 (7.1%) | 10 (71.4%) | 1 (7.1%) | 2 (14.3%) | 1 (7.1%) | 4 (28.6%) |
Diuretics | 4 (36.4%) | 0 (0.0%) | 2(18.2%) | 6 (54.6%) | 0 (0.0%) | 5 (45.4%) | 0 (0.0%) | 5 (45.4%) |
ACEIs | 3 (20.0%) | 4 (26.7%) | 4(26.7%) | 11 (73.3%) | 1 (6.7%) | 3 (20.0%) | 0 (0.0%) | 4 (26.7%) |
Angiotensin II receptor antagonist | 5 (41.7%) | 2 (16.6%) | 1 (8.3%) | 8 (66.7%) | 0 (0.0%) | 4 (33.3%) | 0 (0.0%) | 4 (33.3%) |
Vasodilators | 0 (0.0%) | 1 (14.3%) | 0 (0.0%) | 1 (14.3%) | 0 (0.0%) | 5 (71.4%) | 1 (14.3%) | 6 (85.7%) |
Others | 1 (7.1%) | 4 (28.6%) | 1 (7.1%) | 6 (42.9%) | 0 (0.0%) | 7 (50.0%) | 1 (7.1%) | 8 (57.1%) |
Class A | 13 (50.0%) | 4 (15.4%) | 1 (3.8%) | 18 (69.2%) | 1 (3.8%) | 6 (23.1%) | 1 (3.8%) | 8 (30.8%) |
Class B | 13 (18.3%) | 16 (22.6%) | 9 (12.7%) | 38 (53.5%) | 1 (1.4%) | 27 (38.1%) | 5 (7.0%) | 33 (46.5%) |
Total | 26 (26.8%) | 20 (20.6%) | 10 (10.3%) | 56 (57.7%) | 2 (2.1%) | 33 (34.0%) | 6 (6.2%) | 41 (42.3%) |