起始剂量达格列净单药治疗对2型糖尿病患者血压影响的荟萃分析

Impact of dapagliflozin monotherapy at starting doses on blood pressure in patients with type 2 diabetes:a meta-analysis

目的达格列净是一种新型口服降糖药物。近年来研究显示达格列净不仅具有低血糖风险低的特点,还具有改善血压的作用。由于各个研究采用的达格列净剂量不尽相同,目前还没有足够的证据说明达格列净在何种剂量情况下就具有上述血压获益的效应。方法利用荟萃分析的方法,通过计算机检索Pubmed,Cochrane,EMBase数据库,评价起始剂量达格列净(5mg,1次/d)是否具有改善血压的作用。结果检索数据库后最终纳入6项研究进行荟萃分析,纳入的6项随机对照试验(RCT)均报道了收缩压、糖化血红蛋白和体质量变化,5项RCT报道了舒张压变化。共纳入受试者986例。荟萃分析显示:达格列净组受试者(n=497)平均收缩压较安慰剂组(n=428)低3.83(95%CI-5.42^-2.25)mm Hg(P<0.01);达格列净组(n=411)受试者平均舒张压较安慰剂组(n=341)低1.99(-2.79^-1.19)mm Hg(P<0.01);达格列净组(n=519)受试者糖化血红蛋白水平较安慰剂组(n=455)低0.61%(-0.72%^-0.50%)(P<0.01);达格列净组(n=526)受试者体质量较安慰剂组(n=460)低1.45(-2.06^-0.85)kg(P<0.01)。结论与安慰剂相比,起始剂量达格列净单药治疗在降糖和减重的同时还具有改善血压的作用。

Objective Dapagliflozin is a new antidiabetic drug. Recent studies have shown that dapagliflozin can not only lower hypoglycemia risk, but also reduce blood pressure （BP）. However, a paucity of information exists on which dose that dapagliflozin could ameliorate BP, given the fact that variable dapagliflozin doses in different clini- cal trials were used. Methods Literature search was performed from Pubmed, Cochrane and EMBase to evaluate whether dapagliflozin monotherapy （at a starting dose of 5 mg once daily） could lower BP. Results The changes of systolic BP （SBP）, hemoglobin Ale （HbAle）, and body weight were recorded from 6 randomized controlled trials {RCT）, and the changes of diastolic BP {DBP） were recorded from 5 RCT. A total of 986 patients were included. Overall analysis revealed that SBP was 3.83 mm Hg lower in patients treated with dapagliflozin （ n = 497 ） than pa- tients in placebo group （n=428） {95% CI -5.42 to -2.25 mm Hg, P〈0. 01）. Likewise, DBP was 1.99 mm Hg lower in patients treated with dapagliflozin （n=411） than patients in placebo group {n=3411 （95% CI --2.79 to -- 1.19 mm Hg, P〈0.01 ）. As compared with placebo （ n = 455 ）, dapagliflozin treatment （ n = 519 ） lead to a re- duction of HbAlc by 0.61% （95% CI -0.72% to --0.50%, P〈0.01}. Meanwhile, body weight in patients un- der dapagliflozin treatment （n=526} was reduced by 1.45 kg （950/00 CI -2.06 to -0.85, P%0.01} as compared with patients in placebo group （n=460}. Conclusion Dapagliflozin monotherapy at starting doses can reduce blood glucose and body weight, as well as blood pressure as compared with placebo treatment.