Evidenced-Based Cardiology
Cochrane Corner: Antihypertensive efficacy of beta-1 selective beta blockers for primary hypertension
Cochrane Corner: eficácia anti-hipertensora dos betabloqueadores seletivos beta-1 na hipertensão essencial
a Serviço de Medicina Interna, Centro Hospitalar S. João EPE, Porto, Portugal
b Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
c Unidade do Porto da Cochrane Portugal, Rede Iberoamericana da Cochrane, Porto, Portugal
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João EPE, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde (CINTESIS), Faculdade de Medicina da Universidade do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidade do Porto da Cochrane Portugal, Rede Iberoamericana da Cochrane, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Cochrane Corner</span>: eficácia anti-hipertensora dos betabloqueadores seletivos beta-1 na hipertensão essencial" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical question</span><p id="par0005" class="elsevierStylePara elsevierViewall">What is the effect of beta-1 selective beta blockers on blood pressure (BP)?<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Objectives</span><p id="par0010" class="elsevierStylePara elsevierViewall">Primary: To quantify the dose-dependent effects of various doses and types of beta-1 selective beta blockers on systolic and diastolic BP in individuals with primary hypertension.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondary: To determine the effects of these drugs on pulse pressure (PP), heart rate (HR) and withdrawal due to adverse effects.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Type and description of study</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors performed a systematic review with meta-analysis of randomized, double-blind, placebo-controlled parallel or cross-over trials comparing any beta-1 selective beta blocker (atenolol, betaxolol, bevantolol, bisoprolol, esmolol, metoprolol, nebivolol, pafenolol and practolol) with placebo, with a duration of follow-up of at least three weeks and with BP measurements at baseline and at least once more between three and 12 weeks after starting treatment. Participants had to have baseline systolic BP of at least 140 mmHg or diastolic BP of at least 90 mmHg, or both, and plasma creatinine levels <1.5 times the normal level.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The following databases were searched: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Hypertension Group Specialised Register, and ClinicalTrials.gov up to October 15, 2015, as well as the references of published articles.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Two authors independently confirmed the inclusion of studies and extracted the data, and discrepancies were resolved by discussion or with the assistance of a third reviewer when necessary. The risk of bias was assessed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The results are presented as mean differences in BP, PP and HR with 95% confidence intervals (CI) and as risk ratios (RR) for withdrawal due to adverse effects.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The meta-analysis was performed using a fixed-effects model unless significant between-study heterogeneity was present, in which case the random-effects model was used.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 56 trials were identified (26 parallel and 30 cross-over) in 7812 primary hypertensive patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Overall, combining the effects of the recommended starting dose and twice the starting dose for each drug, beta-1 selective beta blockers reduced systolic BP by 10.4 mmHg, diastolic BP by 8.3 mmHg (95% CI 7.8-8.7), PP by 1.8 mmHg (95% CI 1.2-2.3) and HR by 10.9 bpm (95% CI 10.4-11.5), all with statistical significance. The RR of withdrawal due to adverse effect was 0.85 (95% CI 0.5-1.45), without statistical significance. The reduction in BP was greater at peak hours (12/9 mmHg) than at trough hours (8/7 mmHg). The quality of evidence as assessed with the GRADE Working Group grades of evidence<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> was low due to significant heterogeneity in the analysis and risk of bias exaggerating the effect.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nebivolol decreased systolic/diastolic BP by 8/6 mmHg, estimated by pooling trials, since no significant differences were found between different dosages (5-20 mg/day). Atenolol, at doses of 50 mg (recommended starting dose) and 100 mg, led to reductions of 13/11 mmHg; comparisons between these two doses were inconclusive, although subgroup analysis showed a fall of 10/8 mmHg for a dose of 50 mg/day and of 15/13 mmHg for a dose of 100 mg/day. One trial was identified as an extreme outlier; if this outlier were removed, the overall decrease from doses of 50 mg/day and 100 mg/day was 11/9 mmHg. For metoprolol, pooled results of doses between 100 mg/day and 400 mg/day showed a decrease of 9/8 mmHg, without a significant dose-response effect; the recommended starting dose of 100 mg/day led to a reduction of 5/5 mmHg. The mean BP lowering effect of bisoprolol was 11/8 mmHg in pooled results, without significant differences between doses from 5 to 20 mg/day. There were two extreme outliers, although the effect of removing these trials from the analysis was not reported.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Selection bias was difficult to assess because of poor reporting in the included studies. The risk of detection bias was considered to be high, but that of attrition bias was low, since there were few losses to follow-up. The risk of reporting bias was considered to be high since most studies did not report withdrawal due to adverse effects, as was the potential for publication bias, due to the existence of the asymmetry of funnel plots.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">Beta-1 selective blockers as monotherapy lowered systolic/diastolic BP by an average of 10/8 mmHg, PP by 2 mmHg and HR by 11 bpm. No difference was found between treatment and placebo regarding withdrawal due to adverse effects, and no graded dose-response effect was seen over the recommended dose range.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Comment</span><p id="par0070" class="elsevierStylePara elsevierViewall">This Cochrane systematic review analyzes a large number of trials with many participants to study the effect of beta-1 selective beta blockers, as a group and individually. This Cochrane Corner focuses on the drugs available on the market in Portugal. It presents the results on BP, PP and HR, and adverse effects by drug and by dose level. It is clear that increasing the dose does not necessarily increase the effect, in contrast to what would empirically be expected.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Despite the large number of trials included, the conclusions of the review point to low quality of evidence, mainly due to the significant heterogeneity in the trials and the presence of extreme outliers that could exaggerate the measured outcome effect. There were considerable methodological differences between trials, due to the long time intervals between the development and study of different drugs, as well as differences in time of BP measurement (peak or trough hours of plasma concentrations) and in study populations. Furthermore, BP was only measured in the physician's office, whereas ambulatory BP measurement is currently recommended.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Clinical implications</span><p id="par0080" class="elsevierStylePara elsevierViewall">Beta blockers were originally developed to treat angina but were also shown to be effective antihypertensive drugs. The mechanism by which they lower BP is not fully understood, and the fact that different beta blockers act on different receptors justifies a systematic review of beta-1 selective beta blockers separately from nonselective,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> partial agonist<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and dual alpha and beta blockers.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> An overall assessment of the Cochrane systematic reviews on these different drugs suggests that beta-1 selective beta blockers are more efficacious than partial agonist and dual alpha and beta blockers and have similar efficacy to nonselective beta blockers, although differences in the methodologies of these reviews should be borne in mind. When comparing subclasses, it is also important to consider tolerability and persistence,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> effects on central BP and metabolic effects,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> as these aspects appear to favor the nonselective beta blocker carvedilol and beta-1 selective beta blockers, particularly nebivolol.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The choice of an antihypertensive drug should take into account its efficacy in reducing BP, its other effects, and the patient's comorbidities. In the 2013 European guidelines for the management of hypertension beta blockers are one of the first-line drug classes recommended as monotherapy,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> although with the caveat that these drugs have not been shown to reduce mortality and have less benefit in preventing target organ damage<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and cardiovascular events.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ethical disclosures</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Protection of human and animal subjects</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Confidentiality of data</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Right to privacy and informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres851878" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec846488" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres851879" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec846487" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical question" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objectives" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Type and description of study" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical implications" ] 11 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 12 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-07-20" "fechaAceptado" => "2016-09-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec846488" "palabras" => array:3 [ 0 => "Hypertension" 1 => "Blood pressure" 2 => "Beta-adrenergic antagonists" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec846487" "palabras" => array:3 [ 0 => "Hipertensão" 1 => "Pressão arterial" 2 => "Betabloqueadores" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Beta blockers are commonly used to treat hypertension. This Cochrane systematic review assessed the effect of beta-1 selective beta blockers on blood pressure (BP), pulse pressure (PP), heart rate (HR) and withdrawal due to adverse effects in patients with primary hypertension. Fifty-six randomized placebo-controlled trials were included, with a total of 7812 patients. These drugs reduced systolic/diastolic BP by 10/8 mmHg, PP by 2 mmHg and HR by 11 bpm; no difference was found between treatment and placebo regarding withdrawal due to adverse effects. Differences in efficacy were observed between the various beta-1 selective beta blockers, which may be due to methodological differences in the trials. The choice of an antihypertensive drug should take into account not only its efficacy in reducing BP but also its tolerability, its efficacy in preventing cardiovascular events, and other factors such as undesirable metabolic effects.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os betabloqueadores são fármacos frequentemente utilizados no tratamento da hipertensão arterial. Esta revisão sistemática da <span class="elsevierStyleItalic">Cochrane</span> avaliou o efeito dos betabloqueadores seletivos beta-1 em doentes com hipertensão essencial, nomeadamente sobre a pressão arterial (PA), pressão de pulso (PP), frequência cardíaca (FC) e abandono devido à ocorrência de efeitos adversos. Foram incluídos 56 ensaios clínicos aleatorizados e controlados por placebo, correspondendo a 7812 doentes. A utilização destes fármacos levou a uma descida da PA sistólica/diastólica de 10/8<span class="elsevierStyleHsp" style=""></span>mmHg, da PP de 2<span class="elsevierStyleHsp" style=""></span>mmHg e da FC de 11<span class="elsevierStyleHsp" style=""></span>bpm; não se encontrou diferença significativa no que diz respeito a abandono devido a efeitos adversos entre estes fármacos e o placebo. Foram encontradas diferenças de eficácia entre os vários betabloqueadores seletivos beta-1, que poderão corresponder a diferenças na metodologia dos estudos. Na escolha de um fármaco para tratamento da hipertensão arterial deve ser tida em consideração a eficácia na redução da PA mas também a sua tolerabilidade, efeito na prevenção de eventos cardiovasculares e efeitos indesejados como os metabólicos.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Nogueira-Silva L, Marques PS, Lima MJ. <span class="elsevierStyleItalic">Cochrane Corner</span>: eficácia anti-hipertensora dos betabloqueadores seletivos beta-1 na hipertensão essencial. Rev Port Cardiol. 2017;36:385–388.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Art. No.: CD007451" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.W.K. Wong" 1 => "H.N. Boyda" 2 => "J.M. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2016" "volumen" => "3" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "GRADE: an emerging consensus on rating quality of evidence and strength of recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.H. Guyatt" 1 => "A.D. Oxman" 2 => "G.E. Vist" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.39489.470347.AD" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2008" "volumen" => "336" "paginaInicial" => "924" "paginaFinal" => "926" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18436948" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Art. No.: CD007452" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure lowering efficacy of nonselective beta-blockers for primary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.W.K. Wong" 1 => "J.M. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2014" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Art. No.: CD007450" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure lowering efficacy of partial agonist beta blocker monotherapy for primary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.W.K. Wong" 1 => "H.N. Boyda" 2 => "J.M. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2014" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Art. No.: CD007449" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood pressure lowering efficacy of dual alpha and beta blockers for primary hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.W.K. Wong" 1 => "A. Laugerotte" 2 => "J.M. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2015" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Economic benefits associated with beta blocker persistence in the treatment of hypertension: a retrospective database analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Chen" 1 => "E. Swallow" 2 => "N. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1185/03007995.2015.1013624" "Revista" => array:6 [ "tituloSerie" => "Curr Med Res Opin" "fecha" => "2015" "volumen" => "31" "paginaInicial" => "615" "paginaFinal" => "622" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25651483" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "β-blockers: a review of their pharmacological and physiological diversity in hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.L. Ripley" 1 => "J.J. Saseen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1060028013519591" "Revista" => array:6 [ "tituloSerie" => "Ann Pharmacother" "fecha" => "2014" "volumen" => "48" "paginaInicial" => "723" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24687542" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Mancia" 1 => "R. Fagard" 2 => "K. Narkiewicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.hjh.0000431740.32696.cc" "Revista" => array:6 [ "tituloSerie" => "J Hypertens" "fecha" => "2013" "volumen" => "31" "paginaInicial" => "1281" "paginaFinal" => "1357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23817082" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.U. Klingbeil" 1 => "M. Schneider" 2 => "P. Martus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2003" "volumen" => "115" "paginaInicial" => "41" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12867233" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Art. No.: CD002003" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beta-blockers for hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.S. Wiysonge" 1 => "H.A. Bradley" 2 => "J. Volmink" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2012" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000005/v1_201706110143/S2174204917301228/v1_201706110143/en/main.assets" "Apartado" => array:4 [ "identificador" => "9924" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000005/v1_201706110143/S2174204917301228/v1_201706110143/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301228?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 54 | 29 | 83 |
| 2024 September | 43 | 26 | 69 |
| 2024 August | 52 | 37 | 89 |
| 2024 July | 40 | 27 | 67 |
| 2024 June | 39 | 33 | 72 |
| 2024 May | 32 | 23 | 55 |
| 2024 April | 25 | 22 | 47 |
| 2024 March | 34 | 24 | 58 |
| 2024 February | 32 | 18 | 50 |
| 2024 January | 30 | 28 | 58 |
| 2023 December | 38 | 39 | 77 |
| 2023 November | 43 | 25 | 68 |
| 2023 October | 40 | 15 | 55 |
| 2023 September | 36 | 20 | 56 |
| 2023 August | 39 | 13 | 52 |
| 2023 July | 38 | 12 | 50 |
| 2023 June | 25 | 13 | 38 |
| 2023 May | 52 | 18 | 70 |
| 2023 April | 22 | 11 | 33 |
| 2023 March | 49 | 31 | 80 |
| 2023 February | 33 | 24 | 57 |
| 2023 January | 30 | 14 | 44 |
| 2022 December | 45 | 26 | 71 |
| 2022 November | 50 | 27 | 77 |
| 2022 October | 58 | 15 | 73 |
| 2022 September | 41 | 34 | 75 |
| 2022 August | 56 | 24 | 80 |
| 2022 July | 56 | 26 | 82 |
| 2022 June | 39 | 27 | 66 |
| 2022 May | 35 | 22 | 57 |
| 2022 April | 41 | 39 | 80 |
| 2022 March | 56 | 40 | 96 |
| 2022 February | 63 | 33 | 96 |
| 2022 January | 61 | 34 | 95 |
| 2021 December | 23 | 19 | 42 |
| 2021 November | 60 | 47 | 107 |
| 2021 October | 125 | 44 | 169 |
| 2021 September | 67 | 37 | 104 |
| 2021 August | 51 | 32 | 83 |
| 2021 July | 36 | 30 | 66 |
| 2021 June | 48 | 19 | 67 |
| 2021 May | 44 | 39 | 83 |
| 2021 April | 117 | 61 | 178 |
| 2021 March | 103 | 40 | 143 |
| 2021 February | 91 | 30 | 121 |
| 2021 January | 68 | 26 | 94 |
| 2020 December | 68 | 23 | 91 |
| 2020 November | 63 | 22 | 85 |
| 2020 October | 36 | 16 | 52 |
| 2020 September | 66 | 10 | 76 |
| 2020 August | 46 | 16 | 62 |
| 2020 July | 67 | 11 | 78 |
| 2020 June | 67 | 14 | 81 |
| 2020 May | 74 | 14 | 88 |
| 2020 April | 84 | 22 | 106 |
| 2020 March | 74 | 25 | 99 |
| 2020 February | 155 | 59 | 214 |
| 2020 January | 60 | 22 | 82 |
| 2019 December | 42 | 23 | 65 |
| 2019 November | 40 | 20 | 60 |
| 2019 October | 57 | 14 | 71 |
| 2019 September | 22 | 13 | 35 |
| 2019 August | 51 | 12 | 63 |
| 2019 July | 44 | 13 | 57 |
| 2019 June | 33 | 23 | 56 |
| 2019 May | 41 | 10 | 51 |
| 2019 April | 15 | 17 | 32 |
| 2019 March | 34 | 14 | 48 |
| 2019 February | 37 | 7 | 44 |
| 2019 January | 13 | 6 | 19 |
| 2018 December | 30 | 12 | 42 |
| 2018 November | 52 | 14 | 66 |
| 2018 October | 98 | 16 | 114 |
| 2018 September | 33 | 13 | 46 |
| 2018 August | 31 | 7 | 38 |
| 2018 July | 18 | 4 | 22 |
| 2018 June | 41 | 8 | 49 |
| 2018 May | 40 | 18 | 58 |
| 2018 April | 66 | 6 | 72 |
| 2018 March | 63 | 11 | 74 |
| 2018 February | 32 | 5 | 37 |
| 2018 January | 65 | 5 | 70 |
| 2017 December | 62 | 18 | 80 |
| 2017 November | 59 | 14 | 73 |
| 2017 October | 35 | 21 | 56 |
| 2017 September | 52 | 27 | 79 |
| 2017 August | 53 | 24 | 77 |
| 2017 July | 48 | 26 | 74 |
| 2017 June | 78 | 30 | 108 |
| 2017 May | 15 | 5 | 20 |
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