Study On The Effectiveness And Economic Evaluation Of Hypertension Combination Drug Regimen

Objective: The paper aims to systematically evaluate the efficacy and safety of angiotensin receptor antagonists combined with dihydropyridine calcium channel blockers and angiotensin receptor antagonists combined with thiazide diuretics in the treatment of essential hypertension from the patient’s perspective with Meta-analysis,and to evaluate the economics of the two combination regimens in the context of realistic treatment costs,and to make a more comprehensive trade-off between their effectiveness and costs,so as to provide a reference for guiding the rational clinical use of drugs,reducing medical costs,improving the resource utilization of drugs,and yielding maximum health outcomes.Methods: A computerized search of Pubmed,Embase,CNKI,Wanfang,and Vipul databases were collected for randomized controlled trials of the treatment of essential hypertension with angiotensin receptor antagonists combined with thiazide diuretics and angiotensin receptor antagonists plus dihydropyridine calcium channel blockers as the experimental and control groups,respectively.for the period of establishment to August 1,2022.A comprehensive search of the relevant literature on the two combination regimens was also conducted by hand searching relevant journals and references to extract relevant information.Meta-analysis was performed using CMA software and economic evaluation was carried out using cost-effectiveness analysis.Results: Meta-analysis showed that systolic blood pressure reduction values:ARB+CCB reduced systolic blood pressure [SMD=-0.280,95% CI(-0.397,-0.162)] better compared to ARB+diuretics.Diastolic blood pressure reduction value: ARB+CCB was more effective in reducing diastolic blood pressure [SMD=-0.113,95% CI(-0.208,-0.018)]compared to ARB+diuretics.BP lowering efficiency: ARB+CCB lowered BP more efficiently [OR=0.749,95% CI(0.576,0.975)] compared to ARB+diuretic.Incidence of adverse reactions: In terms of incidence of adverse reactions,ARB+diuretics were significantly higher than ARB+CCB,i.e.ARB+CCB was safer [OR=2.060,95% CI(1.731,2.452)].Subgroup analysis showed that ARB + CCB consistently outperforms ARB + diuretics in lowering systolic blood pressure across treatment duration;in lowering diastolic blood pressure: ARB+CCB was more effective than ARB+diuretics at 8 weeks and less;and between the two groups at 12 weeks and more,the lowering effect was comparable.In terms of antihypertensive efficiency: the antihypertensive efficiency of ARB+CCB was better than that of ARB+diuretic at 4 weeks and less;the antihypertensive efficiency between ARB+diuretic and ARB+CCB was comparable at 8 weeks and more.In terms of the incidence of adverse reactions: ARB+CCB with different treatment durations had a lower incidence of adverse reactions than ARB+diuretics.The results of the economic evaluation showed that the short-term economic performance of the Irbesartan + Hydrochlorothiazide group was better than that of the Irbesartan + Amlodipine group in terms of the magnitude of blood pressure reduction and blood pressure lowering efficiency.There was no significant difference in the short-term economy between the alisartan + indapamide and alisartan + amlodipine besylate groups in terms of the magnitude of blood pressure reduction.The alisartan + indapamide group was more economical than the alisartan + amlodipine besylate group in terms of blood pressure lowering efficiency.The valsartan + amlodipine group had to pay $2,591.1 more to reduce systolic blood pressure by 1 mm Hg and $2,757.0 more to reduce diastolic blood pressure by1 mm Hg than the valsartan + hydrochlorothiazide group.In terms of antihypertensive efficiency,the valsartan + amlodipine group needed to pay $1,144.4 more than the valsartan+ hydrochlorothiazide group to achieve 1% more antihypertensive efficacy.The valsartan +lacidipine group had to pay $527.8 more to reduce systolic blood pressure by 1mm Hg and$923.6 more to reduce diastolic blood pressure by 1mm Hg than the valsartan +hydrochlorothiazide group.In terms of blood pressure lowering efficiency,the valsartan +lacidipine group had to pay $415.1 more than the valsartan + hydrochlorothiazide group to obtain 1% more blood pressure lowering efficiency.Conclusions: 1.Both combination regimens were effective in lowering systolic and diastolic blood pressure in patients,and ARB+CCB was significantly more effective than ARB+diuretic in lowering systolic blood pressure;ARB+CCB was more effective than ARB+diuretic in lowering diastolic blood pressure at 8 weeks and less;ARB+CCB was more effective than ARB+diuretic in lowering blood pressure at 4 weeks and less;the incidence of adverse reactions was lower for ARB+CCB than for ARB+CCB had a lower incidence of adverse effects than ARB+diuretics.Overall,ARB+CCB is more effective than ARB+diuretics in the treatment of hypertension and has a relatively higher safety profile.2.Some of the ARB+CCB groups were not significantly more economical than the ARB+diuretic group,while some of the ARB+CCB groups not only had better antihypertensive effects than the ARB + diuretic group,but were also more economical,such as the valsartan + amlodipine group,which resulted in better quality of health improvements for patients.