The highest burden of hypertension is found in Sub-Saharan Africa (SSA) with a threefold greater mortality from stroke and other associated diseases. Ethnicity is known to influence the response to antihypertensives, especially in black populations living in North America and Europe. We sought to outline the impact of all commonly used pharmacological agents on both blood pressure reduction and cardiovascular morbidity and mortality in SSA. We used similar criteria to previous large meta-analyses of blood pressure agents but restricted results to populations in SSA. Quality of evidence was assessed using a risk of bias tool. Network meta-analysis with random effects was used to compare the effects across interventions and meta-regression to explore participant heterogeneity. Thirty-two studies of 2860 participants were identified. Most were small studies from single, urban centres. Compared with placebo, any pharmacotherapy lowered SBP/DBP by 8.51/8.04 mmHg, and calcium channel blockers (CCBs) were the most efficacious first-line agent with 18.46/11.6 mmHg reduction. Fewer studies assessing combination therapy were available, but there was a trend towards superiority for CCBs plus ACE inhibitors or diuretics compared to other combinations. No studies examined the effect of antihypertensive therapy on morbidity or mortality outcomes. Evidence broadly supports current guidelines and provides a clear rationale for promoting CCBs as first-line agents and early initiation of combination therapy. However, there is a clear requirement for more evidence to provide a nuanced understanding of stroke and other cardiovascular disease prevention amongst diverse populations on the continent. PROSPERO, CRD42019122490. This review was registered in January 2019.

中文翻译：

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撒哈拉以南非洲高血压的药物治疗：系统评价和网络荟萃分析。


撒哈拉以南非洲地区高血压负担最重，中风和其他相关疾病的死亡率高出三倍。众所周知，种族会影响抗高血压药物的反应，尤其是生活在北美和欧洲的黑人群体。我们试图概述所有常用药物对 SSA 血压降低和心血管发病率和死亡率的影响。我们使用了与之前对降压药进行的大型荟萃分析类似的标准，但将结果限制在 SSA 人群中。使用偏倚风险工具评估证据质量。使用随机效应的网络荟萃分析来比较干预措施和荟萃回归的效果，以探索参与者的异质性。确定了 2860 名参与者的 32 项研究。大多数都是来自单一城市中心的小型研究。与安慰剂相比，任何药物治疗均可使 SBP/DBP 降低 8.51/8.04 mmHg，钙通道阻滞剂 (CCB) 是最有效的一线药物，降低 18.46/11.6 mmHg。评估联合治疗的研究较少，但与其他组合相比，CCB 加 ACE 抑制剂或利尿剂有优越性的趋势。没有研究检查抗高血压治疗对发病率或死亡率结果的影响。证据广泛支持当前的指南，并为推广 CCB 作为一线药物和早期开始联合治疗提供了明确的理由。然而，显然需要更多证据来对非洲大陆不同人群的中风和其他心血管疾病预防提供细致入微的了解。普洛斯彼罗，CRD42019122490。该评论注册于 2019 年 1 月。