Comparative effectiveness of physical activity interventions and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: protocol for a systematic review and network meta-analysis

C Noone, C P Dwyer, J Murphy, J Newell, G J Molloy, C Noone, C P Dwyer, J Murphy, J Newell, G J Molloy

Abstract

Background: The prevalence of hypertension is a major public health challenge. Despite it being highly preventable, hypertension is responsible for a significant proportion of global morbidity and mortality. Common methods for controlling hypertension include prescribing anti-hypertensive medication, a pharmacological approach, and increasing physical activity, a behavioural approach. In general, little is known about the comparative effectiveness of pharmacological and behavioural approaches for reducing blood pressure in hypertension. A previous network meta-analysis suggested that physical activity interventions may be just as effective as many anti-hypertensive medications in preventing mortality; however, this analysis did not provide the comparative effectiveness of these disparate modes of intervention on blood pressure reduction. The primary objective of this study is to use network meta-analysis to compare the relative effectiveness, for blood pressure reduction, of different approaches to increasing physical activity and different first-line anti-hypertensive therapies in people with hypertension.

Methods: A systematic review will be conducted to identify studies involving randomised controlled trials which compare different types of physical activity interventions and first-line anti-hypertensive therapy interventions to each other or to other comparators (e.g. placebo, usual care) where blood pressure reduction is the primary outcome. We will search the Cochrane Library, MEDLINE and PsycInfo. For studies which meet our inclusion criteria, two reviewers will extract data independently and assess the quality of the literature using the Cochrane Risk of Bias Tool. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of reduction of both systolic and diastolic blood pressure.

Discussion: This study will provide evidence regarding the comparability of two common first-line treatment options for people with hypertension. It will also describe the extent to which there is direct evidence regarding the comparative effectiveness of increasing physical activity and initiating anti-hypertensive therapy.

Systematic review registration: PROSPERO CRD42017070579.

Keywords: Anti-hypertensives; Blood pressure; Hypertension; Network meta-analysis; Physical activity.

Conflict of interest statement

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The authors declare that they have no competing interests.

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References

    1. Daskalopoulou SS, Khan NA, Quinn RR, Ruzicka M, McKay DW, Hackam DG, et al. The 2012 Canadian hypertension education program recommendations for the Management of Hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol. 2012;28:270–287. doi: 10.1016/j.cjca.2012.02.018.
    1. Hawkins SA, Cockburn MG, Hamilton ANNS, Mack TM. An Estimate of Physical Activity Prevalence in a Large Population-Based Cohort. Med Sci in Sports and Exer. 2004;36(2):253–260. doi: 10.1249/01.MSS.0000113485.06374.0E.
    1. Papathanasiou G, Zerva E, Zacharis I, Papandreou M, Papageorgiou E, Tzima C, et al. Association of High Blood Pressure with Body Mass Index , Smoking and Physical Activity in Healthy Young Adults. Open Cardiovasc Med J. 2015;9:5–17. doi: 10.2174/1874192401509010005.
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr, et al. Seventh report of the joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–1252. doi: 10.1161/01.HYP.0000107251.49515.c2.
    1. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8) JAMA - J Am Med Assoc. 2014;311:507–520. doi: 10.1001/jama.2013.284427.
    1. Olives C, Myerson R, Mokdad AH, Murray CJL, Lim SS. Prevalence, Awareness, Treatment, and Control of Hypertension in United States Counties, 2001–2009. PLoS One. 2013;8(4):e60308. doi: 10.1371/journal.pone.0060308.
    1. American College of Sports Medicine . Guidelines for exercise testing and prescription. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2013.
    1. World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva; 2009.
    1. Zheng L, Sun Z, Zhang X, Xu C, Li J, Hu D, et al. Predictors of progression from prehypertension to hypertension among rural Chinese adults: results from Liaoning Province. Eur J Cardiovasc Prev Rehabil. 2010;17:217–222. doi: 10.1097/HJR.0b013e328334f417.
    1. Ding D, Lawson KD, Kolbe-alexander TL, Finkelstein EA, Katzmarzyk PT, Van MW, et al. The economic burden of physical inactivity: a global analysis of major non-communicable diseases. Lancet. 2016;388:1311–1324. doi: 10.1016/S0140-6736(16)30383-X.
    1. Cornelissen VA, Smart NA, Survey NE. Exercise training for blood Pressure: a systematic review and Meta- analysis. 2012.
    1. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian cardiac outcomes trial-blood pressure lowering arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906. doi: 10.1016/S0140-6736(05)67185-1.
    1. Jm W, Vm M. First-line drugs for hypertension (review) 2009.
    1. Khan N, Bacon SL, Khan S, Perlmutter S, Gerlinsky C, Dermer M, et al. Hypertension management research priorities from patients, caregivers, and healthcare providers: a report from the hypertension Canada priority setting partnership group. J Clin Hypertens. 2017;19:1063–1069. doi: 10.1111/jch.13091.
    1. Tedla YG, Bautista LE. Drug side effect symptoms and adherence to antihypertensive medication. Am J Hypertens. 2016;29:772–779. doi: 10.1093/ajh/hpv185.
    1. Rajpura JR, Nayak R. Role of illness perceptions and medication beliefs on medication compliance of elderly hypertensive cohorts. J Pharm Pract. 2014;27:19–24. doi: 10.1177/0897190013493806.
    1. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug interventions on mortality outcomes : metaepidemiological study. Bmj. 2013;347:f5577. doi: 10.1136/bmj.f5577.
    1. Greco T, Biondi-Zoccai G, Saleh O, Pasin L, Cabrini L, Zangrillo A, et al. The attractiveness of network meta-analysis: a comprehensive systematic and narrative review. Hear lung Vessel. 2015;7:133–142.
    1. Biondi-zoccai G, Umberto B, Frati G. Network meta-analysis for evidence syntesis: What is it and why is it posed to dominate cardiovascular decision making? Int J Cardiol. 2015;182:309–314. doi: 10.1016/j.ijcard.2015.01.023.
    1. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1–9. doi: 10.1186/2046-4053-4-1.
    1. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777–784. doi: 10.7326/M14-2385.
    1. Jansen JP, Trikalinos T, Cappelleri JC, Daw J, Andes S, Eldessouki R, et al. Indirect Treatment Comparison/Network Meta-Analysis Study Questionnaire to Assess Relevance and Credibility to Inform Health Care Decision Making: An ISPOR-AMCP-NPC Good Practice Task Force Report. Value Health. 2014;17:157–173. doi: 10.1016/j.jval.2014.01.004.
    1. Hutton B, Tetzlaff J, Yazdi F, Thielman J, Kanji S, Fergusson D, et al. Comparative effectiveness of monotherapies and combination therapies for patients with hypertension: protocol for a systematic review with network meta-analyses. Syst Rev. 2013;2:44. doi: 10.1186/2046-4053-2-44.
    1. NICE . Hypertension in adults: diagnosis and management. 2016.
    1. Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013;15:659–668. doi: 10.1007/s11906-013-0386-8.
    1. Caspersen CJ, Powell KE, Christenson G. Physical activity, exercise and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–131.
    1. Ghadieh AS. Evidence for exercise training in the management of hypertension in adults. Can Fam Physician. 2015;61:233–239.
    1. Hagins M, States R, Selfe T, Innes K. Effectiveness of Yoga for Hypertension: Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2013;2013:649836.
    1. Williams PT, Thompson PD. Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arterioscler Thromb Vasc Biol. 2013;33:1085–1091. doi: 10.1161/ATVBAHA.112.300878.
    1. Chandrasekaran B, Arumugam A, Davis F, Kumaran DS, Chandrasharma B, Khundrakpam C, et al. Resistance exercise training for hypertension (protocol) 2010.
    1. Li L, Watson M, Mulvaney C, Dm S, Esy C. Walking for hypertension (protocol) 2010.
    1. Mj O, Mc G, Lanas F, Mj M, Seron P. Interval training exercise for hypertension (protocol) 2017.
    1. Endnote X7 Referencing Software. 2016.
    1. Covidence systematic review software. 2017;6:249.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000100. doi: 10.1371/journal.pmed.1000097.
    1. Dias S, Sutton AJ, Ades AE, Welton NJ. Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network Meta-analysis of randomized controlled trials. Med Decis Mak. 2013;33:607–617. doi: 10.1177/0272989X12458724.
    1. Chaimani A, Higgins JPT, Mavridis D, Spyridonos P, Salanti G. Graphical tools for network Meta-analysis in STATA. PLoS One. 2013;8(10):e76654. doi: 10.1371/journal.pone.0076654.
    1. Higgins JPT, Altman DG, Sterne JAC. Cochrane Handb Syst Rev Interv Version 510. 2011. Chapter 8: Assessing risk of bias in included studies.
    1. Chaimani A, Caldwell DM, Li T, Higgins JPT, Salanti G. Additional considerations are required when preparing a protocol for a systematic review with multiple interventions. J Clin Epidemiol. 2017;83:65–74. doi: 10.1016/j.jclinepi.2016.11.015.
    1. Salanti G. Indirect and mixed-treatment comparison, network, or multiple- treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool ‡. Res Synth Methods. 2012;3(2):80–97. doi: 10.1002/jrsm.1037.
    1. Stata Statistical Software: Release 14. 2015.
    1. Lunn DJ, Thomas A, Best N, Spiegelhalter D. WinBUGS---a Bayesian modelling framework: concepts, structure, and extensibility. Stat Comput. 2000;10
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta-Analysis. Chichester: John Wiley & Sons;2011.
    1. Gelman A, Rubin DB. Inference from iterative simulation using multiple sequences. Stat Sci. 1992;7:457–472. doi: 10.1214/ss/1177011136.
    1. Brooks SP, Gelman A. General methods for monitoring convergence of iterative simulations. J Comput Graph Stat. 1998;7(4):434–455.
    1. Jackson D, Barrett JK, Rice S, White IR, Higgins JPT. A design-by-treatment interaction model for network meta-analysis with random inconsistency effects. Stat Med. 2014;33:3639–3654. doi: 10.1002/sim.6188.
    1. Brignardello-Petersen R, Bonner A, Alexander PE, Siemieniuk RA, Furukawa TA, Rochwerg B, Hazlewood GS, Alhazzani W, Mustafa RA, Murad MH, Puhan MA. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol. 2018;93:36–44. doi: 10.1016/j.jclinepi.2017.10.005.
    1. Salanti G, Del Giovane C, Chaimani A, Caldwell DM, JPT H. Evaluating the Quality of Evidence from a Network Meta- Analysis. PLoS One. 2014;9:e99682–7. doi: 10.1371/journal.pone.0099682.
    1. Slattery BW, Haugh S, Francis K, O’Connor L, Barrett K, Dwyer CP, et al. Protocol for a systematic review with network meta-analysis of the modalities used to deliver eHealth interventions for chronic pain. Syst Rev. 2017;6:45. doi: 10.1186/s13643-017-0414-x.

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