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First-line combination therapy versus first-line monotherapy for primary hypertension

Overview of attention for article published in Cochrane database of systematic reviews, January 2017
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (95th percentile)
  • High Attention Score compared to outputs of the same age and source (83rd percentile)

Mentioned by

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79 tweeters
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3 Facebook pages

Citations

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11 Dimensions

Readers on

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112 Mendeley
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Title
First-line combination therapy versus first-line monotherapy for primary hypertension
Published in
Cochrane database of systematic reviews, January 2017
DOI 10.1002/14651858.cd010316.pub2
Pubmed ID
Authors

Javier Garjón, Luis Carlos Saiz, Ana Azparren, José J Elizondo, Idoia Gaminde, Mª José Ariz, Juan Erviti

Abstract

Starting with one drug and starting with a combination of two drugs are strategies suggested in clinical guidelines as initial treatment of hypertension. The recommendations are not based on evidence about clinically relevant outcomes. Some antihypertensive combinations have been shown to be harmful. The actual harm-to-benefit balance of each strategy is unknown. To determine if there are differences in clinical outcomes between monotherapy and combination therapy as initial treatment for primary hypertension. We searched the Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 2), Ovid MEDLINE, Ovid Embase, LILACS, ClinicalTrials.gov, Current Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to February 2016. We searched in clinical studies repositories of pharmaceutical companies, reviews of combination drugs in Food and Drug Administration and European Medicines Agency, and lists of references in reviews and clinical practice guidelines. Randomized, double-blind trials with at least 12 months' follow-up in adults with primary hypertension (systolic blood pressure/diastolic blood pressure 140/90 mmHg or higher, or 130/80 mmHg or higher if participants had diabetes), which compared combination of two first-line antihypertensive drug with monotherapy as initial treatment. Trials had to include at least 50 participants per group and report mortality, cardiovascular mortality, cardiovascular events or serious adverse events. Two authors independently selected trials for inclusion, evaluated the risk of bias and entered the data. Primary outcomes were mortality, serious adverse events, cardiovascular events and cardiovascular mortality. Secondary outcomes were withdrawals due to drug-related adverse effects, reaching blood pressure control (as defined in each trial) and blood pressure change from baseline. Analyses were based on the intention-to-treat principle. We summarized data on dichotomous outcomes as risk ratios with 95% confidence intervals. We found three studies in which a subgroup of participants met our inclusion criteria. None of the studies focused solely on people initiating antihypertensive treatment so we asked investigators for data for this subgroup (monotherapy: 335 participants; combination therapy: 233 participants). They included outpatients, and mostly European and white people. Two trials included only people with type 2 diabetes, whereas the other trial excluded people treated with diabetes, hypocholesterolaemia or cardiovascular drugs. The follow-up was 12 months in two trials and 36 months in one trial. Certainty of evidence was very low due to the serious imprecision, and for using a subgroup not defined in advance. Confidence intervals were extremely wide for all important outcomes and included both appreciable harm and benefit. The numbers of included participants and, hence the number of events, were too small to draw any conclusion about the relative efficacy of monotherapy versus combination therapy as initial treatment for primary hypertension. There is a need for large clinical trials that address the question and report clinically relevant endpoints.

Twitter Demographics

The data shown below were collected from the profiles of 79 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 112 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 112 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 25 22%
Student > Bachelor 20 18%
Researcher 14 13%
Student > Ph. D. Student 10 9%
Other 8 7%
Other 13 12%
Unknown 22 20%
Readers by discipline Count As %
Medicine and Dentistry 42 38%
Nursing and Health Professions 19 17%
Pharmacology, Toxicology and Pharmaceutical Science 10 9%
Social Sciences 4 4%
Psychology 3 3%
Other 9 8%
Unknown 25 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 46. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 05 August 2017.
All research outputs
#414,002
of 14,337,042 outputs
Outputs from Cochrane database of systematic reviews
#1,134
of 10,949 outputs
Outputs of similar age
#17,059
of 376,798 outputs
Outputs of similar age from Cochrane database of systematic reviews
#31
of 193 outputs
Altmetric has tracked 14,337,042 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 97th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 10,949 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.8. This one has done well, scoring higher than 89% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 376,798 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 95% of its contemporaries.
We're also able to compare this research output to 193 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 83% of its contemporaries.