钙离子拮抗剂和血管紧张素Ⅱ受体阻断剂对高血压患者动脉僵硬度影响的Meta分析

Meta Analysis of the Changes of Arterial Stiffness of Hypertension Patients with CCB or ARB

目的系统评价钙离子拮抗剂(CCB)和血管紧张素Ⅱ受体阻断剂(ARB)对高血压患者血管功能的作用差异。方法按循证医学的要求,制定相应的纳入、排除标准及其检索策略。通过PubMed、Embase、Ovid EMBReviews、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库检索相关的临床对照研究,检索各数据库从建库至2012年1月;纳入CCB和ARB治疗原发性高血压的随机对照试验。采用RevMan5.0软件进行统计分析。比较CCB和ARB对高血压患者脉搏波传导速度、收缩压、舒张压、脉压等指标的影响。结果共纳入6个随机对照试验,共计411例患者。Meta分析结果显示,ARB在改善动脉僵硬度方面优于CCB(均数差为183.33,95%CI为79.32～287.33),差异有统计学意义。但是在降低收缩压(均数差为-2.66,95%CI为-3.35～-1.96)和舒张压(均数差为-5.43,95%CI为-8.8～-2.07)方面较CCB弱。结论 ARB在改善高血压患者动脉僵硬度方面优于CCB,该作用与其降压作用无关。但仍需要大样本多中心的随机对照临床试验来进一步证实。

Aira To evaluate the differences of the changes of arterial stiffness of hypertension patients with the treatment of calcium channel blocker （CCB） or angiotensin Ⅱ receptor blocker （ARB）. Methods Based on the principles of evidence-based medicine, corresponding inclusion and exclusion criteria, along with search strategies were de- veloped. We searched the Ovid EMB Reviews, Pubmed, EMBASE, Chinese Biomedical Literature Database, Chinese Scientific Journal Full-text Database, and Chinese Journal Full-text Database up to January 2012 to identify randomized controlled trials （RCT） comparing the effects of CCB with that of ARB on arterial stiffness of hypertension patients. Two reviewers independently evaluated the quality of the included studies, extracted data with a unified form, and analyzed the data by Cochrane Collaboration＇ s RevMan 5.0 software. We compared the effects of CCB with ARB on pulse wave veloci- ty （PWV）, SBP, DBP and PP of hypertension patients. Results Six RCT involving 411 paitents were included. The results of Meta analysis suggested that ARB was better than CCB in reducing arterial stiffness （MD = 183.33, 95% CI was 79. 32- 287.33）, but worse than CCB in loweringSBP （MD= -2.66, 95%CIwas -3.35 - -1.96） or DBP （MD = -5.43, 95%CI was -8.8 - -2. 07）. Conclusion In the treatment of anti-hypertension, CCB is stronger than ARB. But, the effect of ARB is better than that of CCB on reducing arterial stiffness. And it＇ s not related to their antihypertensive function. However, due to the quality of the included studies, the effects of CCB and ARB on arterial stiffness need ,to be confirmed by large multicenter randomized controlled trials.