氯沙坦与卡托普利治疗原发性高血压有效性和安全性的系统评价

Effect and safety of losartan and captopril for the treatment of essential hypertension: A systematic review

目的评价氯沙坦和卡托普利治疗原发性高血压的临床疗效与安全性。方法检索中国期刊全文数据库CNKI(1994-2008.10),中国生物医学文献数据库CBMdisc(1978-2008.10),中文科技期刊全文数据库VIP(1989-2008.10),万方数字化期刊全文数据库(1982-2008.10),PubMed(1966-2008.10),Cochrane Library(2008年第4期),EMBASE(1900-2008.10),SCI(1974-2008.10)等数据库并辅以手工检索。按照纳入排除标准纳入文献,由两位研究者独立筛选并提取资料,纳入关于氯沙坦与卡托普利治疗原发性高血压的随机、半随机对照试验,采用Cochrane评价手册4.2.6推荐的质量标准评价纳入研究的质量,采用RevMan4.2.10软件进行统计学处理。结果纳入11个研究(1 458例患者)。Meta分析结果显示,①疗程为4周时:氯沙坦比卡托普利降低诊室收缩压更明显[WMD=0.59,95%CI(0.22～0.55),P=0.00];两组对诊室舒张压的疗效差异无统计学意义[WMD=-0.08,95%CI(-1.11～0.94),P=0.87]。②疗程为8周时:两组对诊室收缩压和诊室舒张压的疗效差异均无统计学意义[WMD=0.26,95%CI(-0.08～0.61),P=0.14],[WMD=0.13,95%CI(-0.28～0.54),P=0.54]。③疗程为12周时:两组对诊室收缩压和诊室舒张压的疗效差异均无统计学意义[WMD=1.75,95%CI(-0.22～3.72),P=0.08],[WMD=1.15,95%CI(-2.81～5.11),P=0.57]。④氯沙坦不良反应发生人数少[OR=0.55,95%CI(0.42～0.73),P=0.00]。结论当前有限证据表明,氯沙坦降压效果好,不良反应率低。由于本文纳入文献少,证据强度有限,因此还需要更多高质量的RCTs来进一步证实。

Objective To assess the efficacy and safety of losartan and captopril for the treatment of essential hypertension. Methods The database was retrieved form China Journal Full-text Database （1994--2008. 10）, Chinese Biomedicine Database （1978--2008. 10）, Chinese Scientific Journals Full-text Database （1989--2008. 10）, WanFang database online （1982--2008. 10）, PubMed （1966--2008. 10）, Cochrane Library （Issue 4, 2008）, EMBASE （1900--2008. 10）, and SCI （1974--2008. 10）. Randomized control trials （RCTs） of losartan and captopril for essential hypertension were included. The methodological quality of included studies was assessed independently by two authors. The quality of the included studies was evaluated by Handbook 4.2. 6 recommend standard. Data were analyzed by RevMan 4. 2. 10 from the Cochrane Collaboration. Results Eleven RCTs （including 1458 patients） met the inclusion criteria. ① Treatment for 4 weeks： There was a significant lowering of clinic systolic blood pressure （SBP） in losartan group compared with that in captopril group [WMD=0. 59, 95%CI （0. 22-0. 55）, P=0. 002]; while no statistically significant difference existed between the two groups in clinic diastolic blood pressure （DBP） EWMD=-0. 08, 95%CI （-1. 11-0. 94）, P=0.87]. ② Treatment for 8 weeks： no significant difference was found between losartan group and captopril group in the lowering of clinic SBP [WMD=0. 26, 95%CI （-0. 08-0. 61）, P=0. 14] and DBP [WMD=0. 13, 95%CI （-0. 28-0. 54）, P=0. 54]. ③ Treatment for 12 weeks： no statistically significant difference existed between the two groups in clinic SBP [WMD=1. 75, 95%CI （--0. 22-3. 72）, P=0. 083 and DBP [WMD=1. 15, 95%CI （--2.81-5. 11）, P=0. 57]. ④ The side effect in losartan group was lower than that in captopril group [OR=0. 55, 95%CI （0.42-0. 73）, P=0. 00]. Conclusions Based on the review, losartan is more effective and safe in lowering SBP compared with captopril. Further high-quality randomized controlled trials are needed to provide reliable evidence on the treatment of patients with essential hypertension.