Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis.

@article{Psaty2003HealthOA,
  title={Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis.},
  author={Bruce M. Psaty and Thomas Lumley and Curt D. Furberg and Gina D. Schellenbaum and Marco Pahor and Michael H. Alderman and Noel S Weiss},
  journal={JAMA},
  year={2003},
  volume={289 19},
  pages={
          2534-44
        }
}
CONTEXT Establishing relative benefit or harm from specific antihypertensive agents is limited by the complex array of studies that compare treatments. Network meta-analysis combines direct and indirect evidence to better define risk or benefit. OBJECTIVE To summarize the available clinical trial evidence concerning the safety and efficacy of various antihypertensive therapies used as first-line agents and evaluated in terms of major cardiovascular disease end points and all-cause mortality… 

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References

SHOWING 1-10 OF 108 REFERENCES
Overview of Randomized Trials of Angiotensin-Converting Enzyme Inhibitors on Mortality and Morbidity in Patients With Heart Failure
TLDR
Total mortality and hospitalization for congestive heart failure are significantly reduced by ACE inhibitors with consistent effects in a broad range of patients.
Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials.
TLDR
Reductions for total mortality and the combined endpoint were similar for various subgroups examined, but patients with the lowest ejection fraction appeared to have the greatest benefit.
Hypertension in the elderly. Implications and generalizability of randomized trials.
TLDR
Randomized trials demonstrate that treating healthy older persons with hypertension is highly efficacious, and five-year morbidity and mortality benefits derived from trials are greater for older than younger subjects.
Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group.
TLDR
The data indicate that compared with doxazosin, chlorthalidone reduces the risk of combined CVD events, particularly CHD death/nonfatal MI, in high-risk hypertensive patients.
...
...