{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:19:41Z","timestamp":1789697981137,"version":"4.0.1"},"reference-count":59,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["bpspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacology Res &amp; Perspec"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Cardiovascular disorders are the leading cause of death in the world. Many organ diseases (kidney, heart, and brain) are substantially more prone to develop in people with hypertension. In the treatment of hypertension, first\u2010line medications are recommended, while imidazoline receptor agonists are not first\u2010line antihypertensives. Our goal was to conduct a network meta\u2010analysis to assess the efficacy and safety of imidazoline receptor agonists. The meta\u2010analysis was performed following the PRISMA guidelines using the PICOS format, considering the CONSORT recommendations. Studies were collected from four databases: PubMed, Cochrane Library, Web of Science, and Embase. A total of 5960 articles were found. After filtering, 27 studies remained eligible for network meta\u2010analysis. Moxonidine reduced blood pressure in sitting position statistically significantly after 8\u2009weeks of treatment (SBP MD: 23.80; 95% CI: 17.45\u201330.15; DBP MD: 10.90; 95% CI: 8.45\u201313.35) compared to placebo. Moreover, moxonidine reduced blood pressure more effectively than enalapril; however, this difference was not significant (SBP MD: 3.10; 95% CI: \u22122.60\u20138.80; DBP MD: 1.30; 95% CI: \u22121.25\u20133.85). Dry mouth was experienced as a side effect in the case of all imidazoline receptor agonists. After 8\u2009weeks of treatment, the appearance of dry mouth was highest with clonidine (OR: 9.27 95% CI: 4.70\u201318.29) and lowest with rilmenidine (OR: 6.46 95% CI: 0.85\u201349.13) compared to placebo. Somnolence was less frequent with moxonidine compared to rilmenidine (OR: 0.63 95% CI: 0.17\u20132.31). Imidazoline receptor agonists were nearly as effective as the first\u2010line drugs in the examined studies. However, their utility as antihypertensives is limited due to their side effects. As a result, they are not first\u2010line antihypertensives and should not be used in monotherapy. However, in the case of resistant hypertension, they are a viable option. According to our findings, from the point of view of safety and efficacy, moxonidine appears to be the best choice among imidazoline receptor agonists.<\/jats:p>","DOI":"10.1002\/prp2.1215","type":"journal-article","created":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T05:18:53Z","timestamp":1716959933000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Not first\u2010line antihypertensive agents, but still effective\u2014The efficacy and safety of imidazoline receptor agonists: A network meta\u2010analysis"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7423-640X","authenticated-orcid":false,"given":"Andr\u00e1s","family":"\u00c9rszegi","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, Institute of Clinical Pharmacy University of Szeged  Szeged Hungary"},{"name":"Albert Szent\u2010Gy\u00f6rgyi Medical Centre Central Pharmacy, University of Szeged  Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4978-7313","authenticated-orcid":false,"given":"R\u00e9ka","family":"Viola","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Institute of Clinical Pharmacy University of Szeged  Szeged Hungary"},{"name":"Albert Szent\u2010Gy\u00f6rgyi Medical Centre Central Pharmacy, University of Szeged  Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6582-5615","authenticated-orcid":false,"given":"Muh Akbar","family":"Bahar","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Institute of Clinical Pharmacy University of Szeged  Szeged Hungary"},{"name":"Department of Pharmacy, Faculty of Pharmacy Universitas Hasanuddin  Makassar Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6086-8819","authenticated-orcid":false,"given":"Barbara","family":"T\u00f3th","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Institute of Clinical Pharmacy University of Szeged  Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imola","family":"Fejes","sequence":"additional","affiliation":[{"name":"Department of Medicine, Albert Szent\u2010Gy\u00f6rgyi Medical Centre University of Szeged  Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8810-700X","authenticated-orcid":false,"given":"Anna","family":"V\u00e1gv\u00f6lgyi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Albert Szent\u2010Gy\u00f6rgyi Medical Centre University of Szeged  Szeged Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4088-3333","authenticated-orcid":false,"given":"Dezs\u0151","family":"Csupor","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Institute of Clinical Pharmacy University of Szeged  Szeged Hungary"},{"name":"Institute for Translational Medicine University of P\u00e9cs  P\u00e9cs Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"World Health Organization.Guideline for the Pharmacological Treatment of Hypertension in Adults.2021."},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308297"},{"key":"e_1_2_14_4_1","volume-title":"Hyperium (Rilmenidine) [Summary of Product Characteristics]","year":"2016"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-42973-3.00026-3"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(86)90724-1"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1124\/pr.118.016311"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1552-4604.1996.tb04174.x"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-7061(00)00227-2"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V123602"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199715011-00002"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007990.pub3"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2018.05.033"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1979.tb00897.x"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"},{"key":"e_1_2_14_17_1","unstructured":"WHO Collaborating Centre for Drug Statistics Methodology.Guidelines for ATC Classification and DDD Assignment 2023.2022."},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkx1121"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1977.tb00714.x"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)90471-7"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1980.tb04904.x"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00635705"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007998009109502"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-3928%2801%2900017-8"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00544037"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1987.tb03068.x"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)90470-5"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(89)90506-8"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199006000-00007"},{"issue":"5","key":"e_1_2_14_31_1","first-page":"31","article-title":"Efficacy and acceptability of rilmenidine in mild to moderate hypertension. A multicentre randomised double\u2010blind trial comparing methyldopa in 157 patients","volume":"82","author":"Wilkinson R","year":"1989","journal-title":"Arch mal Coeur Vaiss"},{"issue":"2","key":"e_1_2_14_32_1","first-page":"153","article-title":"Double\u2010blind controlled study of rilmenidine versus hydrochlorothiazide in mild hypertension\u2014clinical and renal hemodynamic evaluation","volume":"7","author":"Licata G","year":"1993","journal-title":"J Hum Hypertens"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005344-199424001-00006"},{"issue":"27","key":"e_1_2_14_34_1","first-page":"1265","article-title":"Rilmenidine, a new antihypertensive agent, in the 1st\u2010line treatment of essential hypertension\u2014a multicenter double\u2010blind study versus atenolol","volume":"20","author":"Dallocchio M","year":"1991","journal-title":"Presse Med"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/080370502760050403"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199205000-00013"},{"issue":"27","key":"e_1_2_14_37_1","first-page":"429","article-title":"Moxonidine vs. captopril in minor to intermediate hypertension. Double\u2010blind study of effectiveness and tolerance","volume":"111","author":"Lotti G","year":"1993","journal-title":"Fortschr Med"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199304013281303"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005344-199220004-00010"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005344-199220004-00009"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1177\/009127008702700107"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199715010-00010"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.16625"},{"key":"e_1_2_14_44_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.3","author":"Higgins JPT","year":"2022"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90042-6"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.2003.01796.x"},{"issue":"5","key":"e_1_2_14_47_1","first-page":"39","article-title":"A multicentre double\u2010blind trial comparing rilmenidine 1 mg and hydrochlorothiazide 25 mg in 244 patients","volume":"82","author":"Fiorentini C","year":"1989","journal-title":"Arch mal Coeur Vaiss"},{"key":"e_1_2_14_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-6175.2005.04377.x"},{"key":"e_1_2_14_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1388-9842(03)00163-6"},{"key":"e_1_2_14_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ehj.2004.09.015"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1201\/9780429460418"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-200018100-00021"},{"key":"e_1_2_14_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/204748730000700110"},{"key":"e_1_2_14_54_1","unstructured":"LengyelM BorbasS ZorandiA.Regression of left ventricular hypertrophy in mild\u2010moderate hypertension in one year of treatment with rilmenidine (presented at the European Heart Journal Oxford Univ Press Great Clarendon St Oxford OX2 6DP England 2000) XXI 101."},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.1177\/147323000803600111"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e328356b850"},{"issue":"4","key":"e_1_2_14_57_1","first-page":"41","article-title":"Comparison of the effectiveness of moxonidine and prestarium in postmenopausal women with mild and moderate arterial hypertension","volume":"84","author":"Bakhshaliev AB","year":"2006","journal-title":"Klin Med (Mosk)"},{"key":"e_1_2_14_58_1","unstructured":"https:\/\/www.neak.gov.hu\/pfile\/file?path=\/letoltheto\/ATFO_dok\/gyogyszer\/forg\/EVES_FORGALOM_2022.zip1&inline=true"},{"key":"e_1_2_14_59_1","unstructured":"National Institute for health and care excellence (NICE).Hypertension in adults: diagnosis and management.2022."},{"key":"e_1_2_14_60_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339"}],"container-title":["Pharmacology Research &amp; Perspectives"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/prp2.1215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T07:45:17Z","timestamp":1718351117000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1002\/prp2.1215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,28]]},"references-count":59,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1002\/prp2.1215"],"URL":"https:\/\/doi.org\/10.1002\/prp2.1215","archive":["Portico"],"relation":{},"ISSN":["2052-1707","2052-1707"],"issn-type":[{"value":"2052-1707","type":"print"},{"value":"2052-1707","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,28]]},"assertion":[{"value":"2024-01-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e1215"}}