替米沙坦对比氨氯地平治疗高血压合并糖尿病的疗效和安全性的Meta分析

Effect and safety of telmisartan and amlodipine in treatment of hypertension complicated with diabetes:a Meta-analysis

目的系统评价替米沙坦对比氨氯地平治疗高血压合并糖尿病的疗效和安全性。方法计算机检索Pubmed、EMBASE、Cochrane Library、中国知网、维普和万方数据库,收集国内外公开发表的替米沙坦与氨氯地平治疗高血压合并糖尿病的随机对照试验(randomized controlled trial,RCT),提取相关数据,采用Rev Man5.3统计软件进行Meta分析。结果共纳入11项RCT,共914例高血压合并糖尿病患者。Meta分析结果显示,替米沙坦降低患者空腹血糖[MD=-0.54,95%CI(-0.87,-0.21),P=0.001]、糖化血红蛋白[MD=-0.60,95%CI(-1.12,-0.07),P=0.03]及HOMA胰岛素抵抗指数[MD=-1.27,95%CI(-1.81,-0.73),P<0.001]均显著优于氨氯地平,2组比较差异均具有统计学意义;2组收缩压[MD=2.39,95%CI(-0.21,4.98),P=0.07]、舒张压[MD=0.17,95%CI(-0.95,1.29),P=0.77]及药物不良反应发生率[RR=0.70,95%CI(0.41,1.19),P=0.19]比较,差异均无统计学意义。结论对于高血压合并糖尿病患者,替米沙坦在降低空腹血糖、糖化血红蛋白和HOMA胰岛素抵抗指数方面疗效优于氨氯地平,降压疗效相当,安全性相似。

Objective To systematically evaluate the efficacy and safety of telmisartan and amlodipine in treatment of hypertension complicated with diabetes. Methods Retrieved from Pub Med,EMBASE,Cochrane library,CNKI,VIP and Wanfang database by computer,randomized controlled trials（ RCTs） about telmisartan versus amlodipine in treatment of hypertension and diabetes were collected,then relevant date were extracted,Metaanalysis was drawn by Rev Man 5. 3 statistical software. Results A total of 11 RCTs were included involving 914 patients. The results of Meta-analysis revealed that telmisartan was better than amlodipine in fasting blood glucose reduction[MD =- 0. 54,95% CI（- 0. 87,- 0. 21）,P = 0. 001 ],glycosylated hemoglobinreduction[MD =- 0. 60,95% CI（- 1. 12,- 0. 07）,P = 0. 03] and HOMA insulin resistance index reduction[MD =- 1. 27,95% CI（- 1. 81,- 0. 73）,P〈0. 001 ],there were statistical significance. There were no significant difference in systolic blood pressure[MD = 2. 39,95% CI（- 0. 21,4. 98）,P = 0. 07],diastolic blood pressure[MD = 0. 17,95% CI（- 0. 95,1. 29）,P = 0. 77] and adverse drug reaction[RR = 0. 70,95% CI（ 0. 41,1. 19）,P = 0. 19]. Conclusion For patients with hypertension and diabetes,telmisartan in decreasing fasting blood glucose,glycosylated hemoglobinand HOMA insulin resistance index is more effective than that of amlodipine,blood pressure in patients with equivalent,antihypertensive and safety are similar.