摘要
目的:对血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体拮抗药(ARB)联合治疗原发性高血压的有效性和安全性进行系统评价。方法:计算机检索Cochrane临床对照试验数据库、PubMed、Embase、中国生物医学文献数据库、中国期刊全文数据库,纳入ACEI和ARB联合治疗原发性高血压的随机或半随机对照的临床试验,对纳入的临床研究进行质量评价和Meta分析。结果:共纳入28篇文献,其中英文文献12篇。文献质量评价Jadad评分4～7分的为6篇,其余22篇低于4分,纳入试验的方法学质量较低。Meta分析结果显示:与单用ACEI治疗比较,联合治疗可降低血压3.54/2.07mmHg,降低24h动态血压2.14/1.00mmHg;与单用ARB治疗比较,联合治疗可降低血压3.10/3.35mmHg,降低24h动态血压3.11/2.30mmHg。与ACEI/ARB单用治疗相比,联合治疗降低左心室质量指数13.17/15.69g·m-2,对于射血分数、心率、尿素氮、肌酐、不良反应发生率等的影响差异无统计学意义。结论:联合治疗较单药治疗能一定程度上降低血压,但作用有限。纳入研究质量较低且缺乏以临床事件为终点的试验研究,目前尚无足够的证据证明联合用药比单药治疗更有效、更安全。有必要开展更多高质量、大样本、长期随访的随机对照试验,以提供更可靠的证据。
OBJECTIVE：To evaluate the effectiveness and safety of angiotensin-converting enzyme inhibitor （ACEI） combined with angiotensin receptor blocker （ARB） in the treatment of primary hypertension.METHODS：Biomedical databases were searched,including Cochrane Central Register of Controlled Trials,PubMed,Embase,CBM-disk and CNKI.Randomized or quasi-randomized controlled trials about ACEI combined with ARB for primary hypertension were collected.Quality evaluation and Meta-analysis were performed for included studies.RESULTS：A total of 28 articles including 12 English articles were included.With Jadad scales,6 trials scored 4～7 and others were less than 4.Methodological quality of included studies was low.Compared with ACEI therapy,the combination therapy of ACEI and ARB reduced clinic blood pressure by 3.54/2.07 mmHg and 24 h ambulatory blood pressure by 2.14/1.00 mmHg.Compared with ARB therapy,the combination therapy reduced clinical blood pressure by 3.10/3.35 mmHg and 24 h ambulatory blood pressure by 3.11/2.30 mmHg.LVMI was reduced by 13.17/15.69 g·m-2 after combination therapy compared with ACEI or ARB therapy.There was no statistical significance in the difference of EF,HR,BUN,Cr and the incidence of ADR.CONCLUSION：Compared with single-drug therapy,combination therapy reduces blood pressure to certain extent but the effect of it is limited.Because of the low quality of RCTs and the lack of RCTs based on the clinical practice,no reliable conclusion can be drawn from our Meta-analysis about its efficacy and safety.It is necessary to conduct high-quality large-scale followed-up RCTs to provide reliable reference.
出处
《中国药房》
CAS
CSCD
北大核心
2010年第34期3222-3226,共5页
China Pharmacy
