Document Detail


The effect of antihypertensive treatment on headache and blood pressure variability in randomized controlled trials: a systematic review.
MedLine Citation:
PMID:  22354262     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Antihypertensive drugs reduce headache but it is unclear whether there are differences between drug classes. Calcium channel blockers (CCBs) decrease variability in systolic blood pressure (SBPV) and stroke risk more than other classes, possibly due to decreased vascular tone. If so, there might be a correlation between drug-class effects on variability in SBP and on headache. We determined antihypertensive class effects on SBPV and headache during follow-up in a systematic review of randomized controlled trials. We determined pooled estimates of treatment effect on group variability in BP (variance ratio, VR) and on the odds ratio for headache (OR) by random-effects meta-analysis. Antihypertensive drugs reduced the incidence of headache compared to placebo (OR = 0.75, 95% CI 0.69-0.82, p < 0.0001, 198 comparisons, 43,672 patients), but there was significant heterogeneity between drug classes (p = 0.0007) with a greater effect of beta-blockers compared to placebo (VR = 0.49, 0.33-0.68, p < 0.0001, 16 trials) or all other drug classes (OR = 0.73, 0.62-0.85, p = 0.0002, 49 trials) and a lack of effectiveness of CCBs (vs. placebo-OR = 0.95, 0.79-1.15, 65 trials; vs. other drugs-OR = 1.19, 1.05-1.35, p = 0.009, 101 trials). Drug-class effects on headache were opposite to effects on variability in SBP (vs. other drugs: CCB-VR = 0.81, 0.71-0.85, p < 0.0001; beta-blocker VR = 1.17, 1.07-1.28, p < 0.0001), but were unrelated to differences in mean SBP. Antihypertensive drugs reduce headache but the effect differs between classes, corresponding to their effects on SBPV and the risk of stroke. This may partly be explained by consistent antihypertensive class effects on vascular tone in the peripheral (variability) and cerebrovascular circulations (headache).
Authors:
Alastair John Stewart Webb; Peter Malcolm Rothwell
Publication Detail:
Type:  Journal Article; Review     Date:  2012-02-22
Journal Detail:
Title:  Journal of neurology     Volume:  259     ISSN:  1432-1459     ISO Abbreviation:  J. Neurol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-04     Completed Date:  2013-01-28     Revised Date:  2014-02-24    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1781-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / pharmacology,  therapeutic use*
Blood Pressure / drug effects*
Databases, Factual / statistics & numerical data
Headache / drug therapy*
Humans
Randomized Controlled Trials as Topic*
Grant Support
ID/Acronym/Agency:
095626//Wellcome Trust; G1000372//Medical Research Council
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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