NNT Analysis And Economic Study On The Effects Of Commonly Used Antihypertensive Drugs On Mortality And Major Cardiovascular Events In Patients With Hypertension

Objective:This study aimed to use Number Needed to Treat(NNT)to evaluate the effects and clinical significance of common antihypertensive drugs including angiotensin-converting enzyme inhibitors(ACEI),angiotensinⅡ receptor blockers(ARB),calcium channel blockers(CCB),β-blockers and thiazide diuretics to reduce mortality and major cardiovascular events in patients with hypertension,and to compare the treatment costs of these five classes of antihypertensive drugs in the prevention of death and major cardiovascular events in patients with hypertension.Methods:PubMed,Embase,Web of Science and Cochrane Library were searched up to August 2020.Data from 35 randomized controlled trials were used to calculate NNT for mortality and major cardiovascular events in patients with hypertension.The clinical significance of these trials was evaluated by comparing the NNT with minimal clinical effect(MCE).And a cost-effectiveness analysis was performed based on NNT derived from 35 major clinical trials of hypertension treatment,and the average purchase price of the representative drug in each drug class.Results:1 Effect of antihypertensive drugs:A total of 35 trials involving 136,916 patients were included in this study.Mean follow-up was 3.6 years.Among the five commonly used antihypertensive drugs,ACEI,CCB and thiazide diuretics reduced all-cause mortality in patients with hypertension,and the corresponding NNTB was 17,68 and 136,respectively.CCB and thiazide diuretics reduced the risk of cardiovascular death,NNTB was 112 and 167,respectively.Except for beta-blockers,the other 4 classes of drugs all reduced the risk of major cardiovascular events,and NNTB was 22 for ACEI,NNTB was 27 for CCB,NNTB was 45 for thiazide diuretics,and NNTB was 94 for ARB.All drug reduced the risk of stroke,and NNTB was 42 for ACEI,NNTB was 48 for CCB,NNTB was 68 for thiazide diuretics,NNTB was 144 for beta-blocker and NNTB was 196 for ARB.ACEI,CCB,and thiazide diuretics reduced the risk of heart failure,and the corresponding NNTB was 13,142,and 147,respectively.But none of these drugs reduced the risk of myocardial infarction.2 Assessment of clinical significance:Results of the clinical evaluation showed that none of these trials had definite clinical significance,41%of the trials had possible clinical significance,55%had inconclusive clinical significance,and one trial had definite no clinical significance.3 Cost-effectiveness analysis:Among the five commonly used antihypertensive agents,thiazide diuretics had the lowest cost for preventing death and major cardiovascular events in patients with hypertension,and the total cost for preventing one death or one cardiovascular event ranging from￥2,957($704)to ￥10,972($2,612)over a 3.6-year treatment period.ARB could only prevent cardiovascular death and stroke in patients with hypertension,and the treatment costs of ARB were ￥319,289($76,003)and￥665,751($158,474),respectively,and it is the highest among the five drugs.The cost of CCB for preventing one death or one cardiovascular event was ranging from ￥26,254($6,249)to ￥138,075($32,867).The treatment cost of ACEI for preventing one death or one cardiovascular event ranked in the middle among the five antihypertensive drugs,with the total cost between￥31,602($7,522)and ￥102,098($24,303).Conclusion:1 Among the five commonly used antihypertensive drugs,ACEI,CCB and thiazide diuretics had favorable effects on reducing the mortality and the occurrence of various adverse cardiovascular events in patients with hypertension,and the therapeutic effects of ACEI and CCB were better than that of thiazide diuretics.While β-blockers and ARB had little effect on individual outcomes,and had no effect on other cardiovascular outcomes.2 The results of these trials had no clear clinical significance,and some of them had only possible clinical significance or inconclusive clinical significance.3 In terms of the cost of treatment,thiazide diuretics had the lowest treatment cost in preventing death and cardiovascular events in patients with hypertension,while ARB had the highest treatment cost.The drug treatment costs of CCB and ACEI are relatively moderate,but the treatment costs were different for different outcome events.These results can provide evidence for the prevention and treatment of hypertension.Thus study also give further suggestion for the formulation and adjustment of related policies in the future.