Classes of Antihypertensive Agents and Mortality in Hypertensive Patients with type 2 Diabetes: network meta-analysis of randomized trials

Abstract Aims The aim of this study was to evaluate the effects of antihypertensive drug classes in mortality in patients with type 2 diabetes. Methods MEDLINE, EMBASE, Clinical Trials and Cochrane Library were searched for randomized trials comparing thiazides, beta-blockers, calcium channel blockers (CCBs), angiotensin-converting inhibitors (ACEi) and angiotensin-receptor blockers (ARBs), alone or in combination for hypertension treatment in patients with type 2 diabetes. Outcomes were overall and cardiovascular mortality. Network meta-analysis was used to obtain pooled effect estimate. Results A total of 27 studies, comprising 49,418 participants, 5647 total and 1306 cardiovascular deaths were included. No differences in total or cardiovascular mortality were observed with isolated antihypertensive drug classes compared to each other or placebo. The ACEi and CCB combination showed evidence of reduction in cardiovascular mortality comparing to placebo [median HR, 95% credibility intervals: 0.16, 0.01–0.82], betablockers (0.20, 0.02–0.98), CCBs (0.21, 0.02–0.97) and ARBs (0.18, 0.02–0.91). In included trials, this combination was the treatment that most consistently achieved both lower systolic and diastolic end of study blood pressure. Conclusions There is no benefit of a single antihypertensive class in reduction of mortality in hypertensive patients with type 2 diabetes. Reduction of cardiovascular mortality observed in patients treated with ACEi and CCB combination may be related to lower blood pressure levels.