强化降压对中老年慢性肾脏病患者心血管及肾脏事件影响的荟萃分析

Effects of intensive blood pressure control on major cardiovascular outcomes and renal outcomes in middle-aged and elderly patients with chronic kidney disease: a meta-analysis

目的比较强化降压与标准降压对中老年慢性肾脏病(CKD)患者心血管及肾脏结局的影响。方法通过计算机检索英文数据库Pubmed、Embase、Cochrane,同时手工检索纳入文献的参考文献,收集截至2017年12月发表的比较中老年CKD患者强化降压与标准降压的随机临床试验,运用RevMan 5.3软件评价中老年CKD患者强化降压对心血管事件及肾脏事件的影响。结果共纳入随机对照试验4项,包含患者8122例,其中强化降压组4057例,标准降压组4065例。分析发现,与标准降压组比较,强化降压组发生心血管病死亡风险降低31%(95%CI 10%~47%,P<0.01),全因死亡风险降低23%(95%CI 8%~36%,P<0.05),综合心血管事件风险降低17%(95%CI 3%~28%,P=0.02)。而两组主要冠状动脉事件(RR=0.88,95%CI 0.70~0.90,P=0.24)和综合肾脏事件(RR=0.92,95%CI 0.70~1.21,P=0.53)差异无统计学意义。结论强化降压能降低中老年CKD患者心血管病死亡率、全因死亡率及综合心血管事件发生率,而在主要冠状动脉事件发生率及综合肾脏事件发生率上没有明显差异。

Objective To systematically review the effects of more versus less intensive blood pressure control in the middle-aged and elderly patients with chronic kidney disease(CKD).Methods Randomised controlled trials and references published before December 2017 about patients receiving intensive blood pressure lowering were searched from Pubmed,Embase and the Cochrane Library.Literature was screened according to the exclusion and inclusion criteria and meta-analysis was conducted using Revman 5.3 software to evaluate cardiovascular and kidney outcomes.Results A total of 4 trials were included involving 8122 patients(4057 patients were in intensive group and 4065 in another).The results of meta-analysis showed that after randomisation,intensive blood pressure lowering treatment achieved risk ratio(RR)reductions for cardiovascular disease death 31%(95%CI 10%-47%,P<0.01),all cause mortality 23%(95%CI 8%-36%,P<0.05),and composite cardiovascular events 17%(95%CI 3%-28%,P=0.02).There were no significant differences between two groups for major coronary events(RR=0.88,95%CI 0.70-0.90,P=0.24)and compasite renal events(RR=0.92,95%CI 0.70-1.21,P=0.53).Conclusions Lower blood pressure targets decrease the incidence of cardiovascular disease death,all cause death and composite cardiovascular disease,however,show no significant effect on the incidence of major coronary events and composite renal events in adults aged 50 or older with CKD.