钙离子拮抗剂和血管紧张素转换酶抑制剂对高血压患者动脉僵硬度影响的荟萃分析

Meta-analysis of the effects of calcium channel blockers and angiotensin-converting-enzyme inhibitor on arterial stiffness in patients with hypertension

目的系统评价钙离子拮抗剂(calcium channel blockers,CCBs)和血管紧张素转换酶抑制剂(angiotensin-converting-enzyme inhibitor,ACEI)对原发性高血压(高血压)患者血管功能作用的差异。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 EBM Reviews、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,计算机检索时间从各数据库建库至2012年1月;同时辅助其他检索,纳入CCBs和ACEI治疗高血压患者的随机对照试验(randomized controlled trials,RCT)。两名评价者独立评价纳入研究的质量,并用统一的表格提取资料,采用RevMan5.0软件进行统计分析。比较CCBs和ACEI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4篇RCT,共计226例患者。文献异质性检验显示数据存在异质性(Q=54.80,P<0.001)。荟萃分析结果显示,ACEI在改善动脉僵硬度方面优于CCBs,差异有统计学意义(标准差=135.01,95%CI:59.87～210.16;Z=3.52,P=0.0004,P<0.05);但在降低收缩压(标准差=-4.73,95%CI:-9.35～-0.12,P<0.04)和舒张压(标准差=-10.42,95%CI:-19.16～-1.69,P<0.02)方面较CCBs弱;在降低脉压(标准差=-6.12,95%CI:-2.3～14.55,P<0.15)方面与CCBs相比,差异无统计学意义。结论ACEI在改善高血压患者动脉僵硬度方面优于CCBs,该作用与其降压作用无关。

Objectives To evaluate the effects of calcium channel blockers （CCBs） and angiotensin-converting-enzyme inhibitor （ACEI） on the vascular function in patients with hypertension. Methods Based on the principles of evidencebased medicine, corresponding inclusion and exclusion criteria, along with search strategies were developed. We searched PubMed, EMBASE, Ovid EBM Reviews, 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 （RCTs）, comparing the effects of CCBs with those of ACEI on arterial stiffness in patients with hypertension. Two reviewers independently evaluated the quality of the included studies, extracted data with a unified form and analyzed the data by Coehrane Collaboration＇s RevMan 5.0 software. The comparisons between the effects of CCBs and ACEI on pulse wave velocity （PWV）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） and pulse pressure （PP） in patients with hypertension were performed. Results Four RCTs involving 226 patients were included. Literature heterogeneity analysis revealed that literature heterogeneity existed （Q=54.80, P〈O.001 ）. Meta-analysis indicated that ACEI was better in improving arterial stiffness than CCBs （standard deviation=135.01, 95%CI： 59.87-210.16; Z=3.52,P=O.OOO4,P〈 0.05）; while the effects of ACEI on lowering SBP （standard deviation=-4.73,95%CI：-9.35 - -0.12,P〈0.04） and DBP （standard deviation=- 10.42, 95%CI ： - 19.16 - - 1.69, P〈0.02） were not so good as those of CCBs. There was no significant difference in lowering pulse pressure between CCBs and ACEI （standard deviation=-6.12, 95%CI：-2.3- 14.55 ,P〈0.15）. Conclusions Effects of ACEI on reducing arterial stiffness is better than CCBs, which is not related to their antihypertensive function.