Standardization according to blood pressure lowering in meta-analyses of antihypertensive trials: comparison of three methodological approaches

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MARC

Brunström, MattiasUmeå universitet,Avdelningen för medicin (author)

Standardization according to blood pressure lowering in meta-analyses of antihypertensive trials : comparison of three methodological approaches

Article/chapterEnglish2018

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Lippincott Williams & Wilkins,2018
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LIBRIS-ID:oai:DiVA.org:umu-143060
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-143060URI
https://doi.org/10.1097/HJH.0000000000001574DOI

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Language:English
Summary in:English

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Subject category:for swepub-publicationtype

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OBJECTIVE: Assess how standardization of relative risks (RRs) and standard errors (SEs), according to blood pressure differences within trials, affects heterogeneity, overall effect estimates and study weights in meta-analyses of antihypertensive treatment.METHOD: Data from a previous systematic review were used. Three sets of analyses were performed, using both random-effects and fixed-effects model for meta-analyses. First, we used raw data from the included trials. Second, we standardized RRs as if SBP was reduced by 10 mmHg in all trials. Third, we standardized both RRs and SEs.RESULTS: When RRs were standardized according to blood pressure lowering, heterogeneity between trials increased (I = 36 vs. 93% for mortality). This conferred large differences in treatment effect estimates using random-effects and fixed-effects model (RR 0.79, 95% confidence interval 0.70-0.89, respectively, 0.97, 0.94-0.99). When SEs were standardized, confidence intervals for individual trials widened, resulting in lower power to detect heterogeneity across trials. Study weights were dissociated from number of events in trials (P < 0.0001, R = 0.99 before standardization vs. P = 0.063, R = 0.05 after standardization). This induced a secondary shift in weight from trials with lower baseline SBP to trials with higher baseline SBP, resulting in exaggerated overall effect estimates.CONCLUSION: Standardization of RRs exaggerates differences between trials and makes meta-analyses highly sensitive to choice of statistical method. Standardization of SEs masks heterogeneity and results in biased effect estimates.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
antihypertensive agents
blood pressure targets
cardiovascular diseases
hypertension
metaanalysis
standardization
systematic review

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Carlberg, BoUmeå universitet,Avdelningen för medicin(Swepub:umu)boca0001 (author)
Umeå universitetAvdelningen för medicin (creator_code:org_t)

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In:Journal of Hypertension: Lippincott Williams & Wilkins36:1, s. 4-150263-63521473-5598

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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