Hypertension induces both structural and functional changes in blood vessels, thereby increasing endothelial dysfunction, which in turn, contributes to an increase in blood pressure. A popular and widely used noninvasive tool, flow-mediated dilation (FMD), is used to examine peripheral artery endothelium-dependent dilation. This study aimed to compare the efficacies of different classes of antihypertensive agents based on their effects on FMD. PubMed, Embase, and Cochrane Library were queried till November 1, 2020. Comparative studies on the efficacies of two or more antihypertensive agents or placebos for hypertensive patients were included. The outcomes were variations in mean systolic and diastolic blood pressure. Two reviewers independently reviewed and filtered the literature and extracted the data; the Cochrane “risk of bias” method was used to evaluate the methodological quality of the randomized controlled trials. A network meta-analysis was performed using Stata 15.0 software with a total of 49 studies. Subgroup analysis based on age and duration of treatments was performed. As compared to the placebo group, patients receiving the antihypertensive drugs exhibited significantly enhanced FMD (ARB + CCB: 4.01%, 95% CI, 0.92–7.11%, ; ACEI + ARB: 2.81%, 95% CI, 1.19–4.43%, ; ACEI: 2.55%, 95% CI, 1.34–3.77%, ; ARB: 2.22%, 95% CI, 1.05–3.38%, ; β-blocker: 2.23%, 95% CI, 0.93–3.52%, ). In the SUCRA curve for network meta-analysis, the combination of CCB and ARB was found to be the most effective in increasing FMD (SUCRA = 89.0%), followed by ACEI monotherapy (SUCRA = 74.2%). ARB combined with CCB was superior in improving the endothelial function measured as the FMD; ACEI monotherapy was the most effective treatment among the antihypertension medications. There were no significant differences between antihypertensive drug-based monotherapies.

中文翻译：

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抗高血压药物在高血压患者血流介导的血管舒张中的比较疗效：随机对照试验的网络荟萃分析

高血压会引起血管结构和功能的变化，从而增加内皮功能障碍，进而导致血压升高。一种流行且广泛使用的非侵入性工具，流动介导扩张 (FMD)，用于检查外周动脉内皮依赖性扩张。本研究旨在根据其对 FMD 的影响比较不同类别的抗高血压药物的疗效。PubMed、Embase 和 Cochrane Library 的查询截止日期为 2020 年 11 月 1 日。纳入了两种或多种抗高血压药物或安慰剂对高血压患者疗效的比较研究。结果是平均收缩压和舒张压的变化。两名审稿人独立审阅、筛选文献并提取数据；Cochrane“偏倚风险”方法用于评估随机对照试验的方法学质量。使用 Stata 15.0 软件对总共 49 项研究进行了网络荟萃分析。进行了基于年龄和治疗持续时间的亚组分析。与安慰剂组相比，接受抗高血压药物治疗的患者 FMD 显着增强（ARB + CCB：4.01%，95% CI，0.92-7.11%，; ACEI + ARB：2.81%，95% CI，1.19–4.43%，; ACEI：2.55%，95% CI，1.34–3.77%，; ARB：2.22%，95% CI，1.05–3.38%，; β-受体阻滞剂：2.23%，95% CI，0.93–3.52%，）。在网络荟萃分析的 SUCRA 曲线中，发现 CCB 和 ARB 的组合在增加 FMD 方面最有效（SUCRA = 89.0%），其次是 ACEI 单药治疗（SUCRA = 74.2%）。ARB联合CCB在改善以FMD衡量的内皮功能方面具有优势；在抗高血压药物中，ACEI 单药治疗是最有效的治疗方法。以抗高血压药物为基础的单一疗法之间没有显着差异。