天麻钩藤饮联合卡托普利治疗原发性高血压的系统评价和Meta分析

Therapeutic Effect of Tianma Gouteng Decoction Combined with Captopril in Treatment of Primary Hypertension : A Systematic Review and Meta-analysis

目的评价天麻钩藤饮联合卡托普利治疗原发性高血压的有效性和安全性,为动物实验和临床推广提供科学依据。方法纳入天麻钩藤饮联合卡托普利与单纯卡托普利治疗原发性高血压的随机对照试验(randomised control trails,RCTs)文献,用Jadad量表对文献的质量进行评分,进行Meta分析。结果共纳入8篇RCTs文献,均是Jadad评分小于3分的低质量研究。两组临床疗效、原发性高血压症状的合并效应量比值比(odds ratio,RR)分别为1.15、1.41;治疗后收缩压、舒张压的合并效应量分别为-5.37、-4.85mmHg,差异均有统计学意义(P<0.05)。两组的不良反应均较少。结论与单纯卡托普利比较,天麻钩藤饮联合卡托普利治疗原发性高血压有更好的临床疗效,可改善症状,降压效果更佳,具有较好的安全性,适合临床的推广使用。由于纳入文献的质量不高,仍需要高质量的大样本双盲RCTs的支持。

Objective To evaluate the therapeutic effect and safety of Tianma Gouteng Decoction combined with captopril in the treatment of primary hypertension and to provide a scientific basis for animal experiment and clinical application. Methods A search was performed to identify the randomized controlled trials （RCTs） of Tianma Gouteng Decoction combined with eaptopril versus captopril alone in the treatment of hypertension. The Jadad scale was used to assess the quality of RCTs. The included trials were subjected to meta-analysis. Results Eight RCTs were included, and all of them were low-quality studies with a Jadad score less than 3. Compared with those receiving captopril alone, the patients receiving Tianma Gouteng Decoction combined with captopril had significantly more improvements in treatment outcome （pooled odds ratio [OR3, 1. 15）, hypertension symptoms （pooled OR, 1.41）, systolic pressure （pooled effect size, -5.37 mmHg）, and diastolic pressure （pooled effect size, -4.85 mmHg） （P〈0.05）. Both groups of patients had few adverse events. Conclusion Compared with captopril alone, Tianma Gouteng Decoction combined with captopril have a better therapeutic effect in the treatment of hypertension. This combination therapy has better symptom-relieving and antihypertensive effects and higher safety and holds promise for clinical application. However, large-sample double-blind RCTs with high quality are still needed due to the poor quality of trials included in this meta-analysis.