ACEI和ARB预防高血压合并房颤患者房颤复发的Meta分析

Meta-analysis:ACEI and ARB prevent recurrence of atrial fibrillation in hypertensive patients with atrial fibrillation

目的:对ACEI和ARB预防高血压合并房颤患者房颤复发的有效性和不良反应发生率进行评价。方法:计算机检索Pubmed(1990–2008年)、Cochrane图书馆临床对照试验资料数据库(1990–2008年)、Google学术网站、中国生物医学文献数据库(1990–2008年)、中国万方数据库(1990–2008年),纳入比较ACEI和ARB与其他降压药物治疗高血压合并房颤患者时预防房颤复发的随机对照研究。文献语种为中文和英文,对纳入研究的方法学质量进行评价,并用RevMan5.0软件进行统计学分析。结果:共有16个随机对照研究入选,病例数总计1919例,治疗组995例,对照组924例。Meta分析结果显示:对于高血压合并房颤的患者而言,ACEI或ARB类药物与对照组比较、ACEI与对照组比较、ARB与对照组比较,在预防房颤发作方面差异有统计学意义,合并效应量分别为[OR合并=0.40,95%C(I0.29,0.56),P<0.00001]、[OR合并=0.42,95%C(I0.26,0.70),P=0.0007]、[OR合并=0.39,95%C(I0.27,0.56),P<0.00001]。ACEI或ARB类药物与其他药物相比在不良反应发生方面差异无统计学意义[OR合并=0.79,95%C(I0.49,1.28),P=0.34]。结论:ACEI和ARB类药物可以预防高血压合并房颤患者房颤的复发。

Objective：To evaluate the efficacy and safety of angiotensin-converting enzyme inhibitor（ACEI） and angiotensin receptor blockers（ARB） in the prevention of recurrence of atrial fibrillation in hypertensive patients with atrial fibrillation.Methods：Pubmed,the clinical trials database of Cochrane Library,Google scholar,the Chinese Biomedicine Database,and the Wanfang Database from 1990 to 2008 were searched.Randomized and controlled trials reporting prevention of recurrence of atrial fibrillation by using ACEI and ARB versus other drugs in hypertensive patients with atrial fibrillation were selected.Only Chinese and English language articles were included.The quality of included studies was evaluated and meta-analysis was performed by RevMan 5.0 software.Results：Sixteen randomized,controlled trials that enrolled 1919 patients met the inclusion criteria.A total of 995 patients received ACEI and ARB,and 924 patients received other anti-hypertensive drugs.The results of meta-analysis showed statistical significance in prevention of atrial fibrillation in hypertensive patients with atrial fibrillation compared ACEI or ARB with other antihypertensive drugs OR =0.40,95%CI（0.29,0.56）,P 0.00001],ACEI with other anti-hypertensive drugs OR =0.42,95%CI（0.26,0.70）,P =0.0007],ARB with other anti-hypertensive drugs OR =0.39,95%CI（0.27,0.56）,P 0.00001].There was no significant difference in occurrence rate of adverse drug reactions between ACEI and ARB versus the other drugs OR =0.79,95%CI（0.49,1.28）,P =0.34].Conclusion：The use of ACEI and ARB had an overall effect on preventing recurrence of atrial fibrillation in hypertensive patients with atrial fibrillation.