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Published in: BMC Medicine 1/2020

01-12-2020 | Hypertension | Research article

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

Authors: Anna Seeley, Josephine Prynn, Rachel Perera, Rebecca Street, Daniel Davis, Anthony O. Etyang

Published in: BMC Medicine | Issue 1/2020

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Abstract

Background

The highest burden of hypertension is found in Sub-Saharan Africa (SSA) with a threefold greater mortality from stroke and other associated diseases. Ethnicity is known to influence the response to antihypertensives, especially in black populations living in North America and Europe. We sought to outline the impact of all commonly used pharmacological agents on both blood pressure reduction and cardiovascular morbidity and mortality in SSA.

Methods

We used similar criteria to previous large meta-analyses of blood pressure agents but restricted results to populations in SSA. Quality of evidence was assessed using a risk of bias tool. Network meta-analysis with random effects was used to compare the effects across interventions and meta-regression to explore participant heterogeneity.

Results

Thirty-two studies of 2860 participants were identified. Most were small studies from single, urban centres. Compared with placebo, any pharmacotherapy lowered SBP/DBP by 8.51/8.04 mmHg, and calcium channel blockers (CCBs) were the most efficacious first-line agent with 18.46/11.6 mmHg reduction. Fewer studies assessing combination therapy were available, but there was a trend towards superiority for CCBs plus ACE inhibitors or diuretics compared to other combinations. No studies examined the effect of antihypertensive therapy on morbidity or mortality outcomes.

Conclusion

Evidence broadly supports current guidelines and provides a clear rationale for promoting CCBs as first-line agents and early initiation of combination therapy. However, there is a clear requirement for more evidence to provide a nuanced understanding of stroke and other cardiovascular disease prevention amongst diverse populations on the continent.

Trial registration

PROSPERO, CRD42019122490. This review was registered in January 2019.
Appendix
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Metadata
Title
Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis
Authors
Anna Seeley
Josephine Prynn
Rachel Perera
Rebecca Street
Daniel Davis
Anthony O. Etyang
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-020-01530-z

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