β受体阻滞剂治疗高血压的疗效荟萃分析

Efficacy of β blockers for hypertension： a systematic review and Meta-analysis

目的用荟萃分析方法评价β受体阻滞剂与其他抗高血压药物治疗原发性高血压疗效。方法计算机检索The Cochrane Library、MEDLINE（1966年至2013年7月）、EMbase（1980年至2013年7月）、CNKI（1980年至2013年7月）、CBM（1980年至2013年7月）和WanFangData（1978年至2013年7月），收集B受体阻滞剂与其他抗高血压药物治疗高血压疗效随机对照试验（Randomized controlled trial，RCT）。2位研究者筛选文献、提取资料并评价质量后，用RevMan5．1．6软件进行荟萃分析。结果共纳入12个研究。Meta结果显示B受体阻滞剂治疗高血压卒中发生数较其他类抗高血压药物高[RR=1．21，95％C／：1．04～1．41，P=0．01]，与钙离子拮抗剂组比较其总死亡数较高[RR=1．07，95％CI：1．00～1．14，P=0．05]。冠心病发生数、心血管病死亡数[RR=1．10，95％C／：0．97—1．25，P=0．13]等两者间差异均无统计学意义。结论B受体阻滞剂治疗高血压与其他抗高血压药物治疗比较，卒中发生风险高，与钙离子拮抗剂比较，总死亡数高，故B受体阻滞剂不应作为治疗原发性高血压首选药物。

Objective To evaluate the efficacy and safety of β blockers and other antihypertensive drugs on morbidity and mortality endpoints in adults with essential hypertension. Methods We searched the Cochrane Librar- y,MEDLINE（ 1966 to July 2013 ）, EMbase （1980 to July 2013 ）, CNKI （1980 to July 2013 ）, CBM （1980 to July 2013 ）, WanFang Data（ 1978 to July 2013 ）. Randomized controlled trials or controlled clinical trials selection and as- sessment were undertaken by two reviewers. The quality of the included studies was evaluated by GRADE system and principle of Cochrane Reviewer Handbook 5.1.6 RCT. Meta-analyses were performed with RevMan 5.1.6 software. Results Twelve randomized studies were selected. The results showed that β blockers had a significantly higher risk of developing a stroke than those on other antihypertensive drugs[ RR = 1.21,95% CI（ 1.04,1.41 ） ,P = 0.01] and total mortality was significantly higher for β blockers compared to CCBs [ RR = 1.07,95 % CI （ 1.00,1.14 ）, P = 0.05 ]. The effect of [3 blockers therapy on coronary heart disease [ RR = 1.02,95 % CI（0. 91,1.15 ） ,P = O. 74 ], car- diovascular mortality [ RR = 1.10,95 % CI（O. 97,1.25 ）, P = 0.13 ] ect. were no significantly different from other anti- hypertensive drugs [ RR = 1.02,95 % CI（0. 91,1.15 ）, P = 0. 74 ]. Conclusion β blocker had a significantly higher risk of developing a stroke than other antihypertensive drugs and total mortality was significantly higher for β blocker compared to CCBs, so the available evidence does not support the use of beta-blockers as first line drugs in the treat- ment of hypertension. Because of the studies limited, further randomized controlled trials is required in this field to the quality of life after surgery and clarify the effect of surgery on ovarian function.