Summary of findings for the main comparison.
Uric acid (UA) lowering drug compared to placebo for hyperuricemia in hypertensive patients
| Uric acid (UA)‐lowering drug compared to placebo for hyperuricemia in hypertensive patients | ||||||
| Patient or population: hyperuricemia in hypertensive patients Setting: several sites in the USA Intervention: uric acid (UA)‐lowering drug Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with Uric acid (UA) lowering drug | |||||
| 24h‐Systolic Blood Pressure | ‐ | MD 6.19 lower (12.82 lower to 0.45 higher) | MD ‐6.2 (‐12.8, 0.5) | 229 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | |
| 24h‐Diastolic Blood Pressure | ‐ | MD 3.92 lower (9.19 lower to 1.36 higher) | MD ‐3.9 (‐9.2, 1.4) | 229 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | |
| Clinic Systolic Blood Pressure | ‐ | MD 8.43 lower (15.24 lower to 1.62 lower) | MD ‐8.4 (‐15.2, ‐1.6) | 120 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | |
| Clinic Diastolic Blood Pressure | ‐ | MD 6.45 lower (13.6 lower to 0.7 higher) | MD ‐6.5 (‐13.6, 0.7) | 120 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | |
| Serum uric acid | ‐ | MD 3.09 lower (3.76 lower to 2.43 lower) | MD ‐3.1 (‐3.8, ‐2.4) | 223 (3 RCTs) | ⊕⊕⊕⊕ HIGH | |
| Withdrawals due to adverse effects | 18 per 1,000 | 34 per 1,000 (8 to 147) | RR 1.86 (0.43 to 8.10) | 241 (3 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 3 4 | NCT01496469 reported only one withdrawal due to adverse events. However, four adverse events were described in the febuxostat group, which might be drug‐related. Therefore, we decided to include all four cases in the assessment of RR for this study. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; RCT: Randomized controlled trial. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded for wide CIs
2 Downgraded for high unexplained heterogeneity
3 Downgraded for small number of events and incomplete reporting
4 Unclear randomisation processes in the largest trial (highest weight in meta‐analysis)