依普利酮治疗原发性高血压量效关系的系统评价

Dose-related blood pressure lowering efficacy of eplerenone in the treatment of primary hypertension

目的:评价依普利酮治疗原发性高血压的量效关系。方法:按纳入标准,电子检索Cochrane图书馆最近一期(2005年第1期)出版的Cochrane对照试验注册数据库,PubMed,Medline,Embase,Ovid,Medscape,TRIP,CBM,NRR;手工检索发表或未发表的文献,包括心血管系统、高血压病的杂志和会议摘要。文献资料用统一的表格,由两名评价者独立提取,对文献质量进行内部真实性评价,并用Revman4.2.7软件对数据进行Meta分析。结果:共检索到随机对照试验(RCT)9篇,经排查符合纳入标准并进入系统评价的文献共3篇,均为高质量RCT。Meta分析结果显示,依普利酮100mg/d与安慰剂比较,诊室收缩压变化的加权均数差(WMD)=-9.17,95%可信区间为(-10.62,-7.72),P<0.01;诊室舒张压变化的WMD=-3.94,95%可信区间为(-4.67,-3.20),P<0.01。结论:依普利酮100mg/d降压是有效的,由于测量指标是终点替代指标(血压变化),故依普利酮的长期疗效仍需进行更多高质量的RCT才能得出肯定性结论。

Objective: To assess the dose-related blood pressure lowering efficacy of eplerenone for essential hypertension. Methods: According to the Cochrane reviewer's handbook, included studies were randomized controlled trials of eplerenone versus placebo. Electronic search was applied to the Cochrane Library CENTRAL published in the latest issue (2005,1), PubMed, Medlime,Embase,Ovid, Medscape, TRIP, CBM, NRR. Published and unpublished papers, including cardiovascular and hypertension journals and meeting abstracts were searched manually. Date were extracted by two independent reviewers extracted data. Trials were assessed for quality. Revman 4.2.7 software developed by the cochrane collaboration was used for meta-analysis. Results: Nine related articles were identified, but only three with patients were eligible and were included in the systematic review. All articles were high quality, from developed countries. Eplerenone 100 mg/d compared with placebo for clinic systolic BP, WMD=-9.17,95%CI(-10.62, -7.72 ), P<0.01;for clinic diastolic BP, WMD=-3.94,95%CI(-4.67,-3.20), P<0.01. Conclusions: Eplerenone 100 mg/d are well effective in reducing BP. Further large randomized, double blind, placebo-controlled trial are needed in long-term efficacy of eplerenone because measured outcomes are insteaded end-point outcome.