HypertensionMeta-analysis
Blood pressure-lowering efficacy of antihypertensive drugs and their combinations: a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials
- Systematic review and meta-analysis of randomised trials
- double-blind
- placebo-controlled
- fixed-effects
Authors' conclusion
These analyses provide robust estimates of the expected blood pressure-lowering effect for any combination of antihypertensive drugs, allowing their efficacy to be classified into low, moderate, and high intensity.
Study context
- Population
- Adults in placebo-controlled trials of antihypertensive drugs, follow-up 4–26 weeks
- Participants
- 104,176 adults · 484 trials
- Comparison
- Antihypertensive monotherapies and combinations vs placebo
- Outcome
- Placebo-corrected reduction in SBP
Pooled result
As reported in the abstract
Placebo-corrected SBP reduction
Each group vs placeboReduction, mm Hg (95% CI)
Monotherapystandard dose
8.7(8.2–9.2)
Dual combinationsone standard dose
14.9(13.1–16.8)
- Additional reduction per dose doubling, monotherapy (mm Hg)
- 1.5 (1.2-1.7)
- Additional reduction per dose doubling of both drugs, dual combinations (mm Hg)
- 2.5 (1.4-3.7)
Further pooled results
Effect of baseline SBP on efficacy, monotherapies
- Efficacy reduction per 10 mm Hg lower baseline SBP (mm Hg)
- 1.3 (1.0-1.5)
- differences between drug classes observed
Intensity classification
- Monotherapies at standard dose classified low intensity (of 57)
- 45 (79%)
- Dual combinations classified moderate intensity (of 189)
- 110 (58%)
- Dual combinations classified high intensity (of 189)
- 21 (11%)
Efficacy model validation on external trials
- Correlation predicted vs observed SBP
- r=0.76, p<0.0001
Original publication
Blood pressure-lowering efficacy of antihypertensive drugs and their combinations: a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials. Lancet. Published 30 August 2025. doi:10.1016/s0140-6736(25)00991-2
Summarised from the published abstract; every number is checked against it