依普利酮治疗原发性高血压疗效和安全性的Meta分析

Curative effect and safety of eplerenone in treatment of essential hypertension:a Meta-analysis

目的系统评价依普利酮治疗原发性高血压疗效与安全性。方法计算机检索EMbase、PubMed、Cochrane图书馆、CNKI、维普及万方数据库,筛选依普利酮治疗原发性高血压的随机对照试验,检索时间为建库至2019年5月,应用RevMan 5.3软件进行Meta分析。结果共纳入15篇文献,包括3900例患者。疗效方面,与安慰剂相比,依普利酮能显著降低收缩压(WMD=-8.70 mmHg,95%CI:-8.84^-8.57,P<0.00001)与舒张压(WMD=-4.49 mmHg,95%CI:-4.58^-4.41,P<0.00001);与其他抗高血压药物总体相比,依普利酮对收缩压(W M D=-3.00 m m H g,95%CI:-3.15^-2.86,P<0.00001)和舒张压(WMD=-0.87 mmHg,95%CI:-0.96^-0.78,P<0.00001)的降低效果更加明显。进一步分析发现,依普利酮降压疗效不及螺内酯(收缩压:WMD=6.40 mmHg,95%CI:5.89~6.91,P<0.00001;舒张压:WMD=3.10 mmHg,95%CI:2.75~3.45,P<0.00001)和依那普利(收缩压:WMD=0.70 mmHg,95%CI:0.05~1.35,P=0.03;舒张压:WMD=1.43 mmHg,95%CI:1.05~1.80,P<0.00001),优于血管紧张素受体拮抗剂(收缩压:WMD=-6.13 mmHg,95%CI:-6.33^-5.94,P<0.00001;舒张压:WMD=-3.19 mmHg,95%CI:-3.31^-3.07,P<0.00001),对收缩压的降低疗效优于氨氯地平(WMD=-0.40 mmHg,95%CI:-0.66^-0.14,P=0.003),对舒张压的降低疗效不及氨氯地平(WMD=2.40 mmHg,95%CI:2.23~2.57,P<0.00001)。安全性方面,与其他抗高血压药物相比,依普利酮其总不良反应和严重不良反应差异无统计学意义。结论依普利酮在原发性高血压治疗方面具有相对有效性与安全性。

Objective To review systematically the curative effect and safety of eplerenone in treatment of essential hypertension(EH).Methods The databases of EMbase,PubMed,Cochrane Library,CNKI,VIP and WanFang Data were retrieved with computer for screening the randomized controlled trials(RCT)about EH treatment with eplerenone from database establishment time to May 2019.A Meta-analysis was conducted by using RevMan5.3 software.Results There were totally 15 documents included involved 3900 cases.Compared with placebo,eplerenone decreased significantly systolic blood pressure(SBP,WMD=-8.70 mmHg,95%CI:-8.84^-8.57,P<0.00001)and diastolic blood pressure(DBP,WMD=-4.49 mmHg,95%CI:-4.58--4.41,P<0.00001).Compared with other anti-hypertension drugs,the reducing effect of eplerenone was more significant on SBP(WMD=-3.00 mmHg,95%CI:-3.15^-2.86,P<0.00001)and DBP(WMD=-0.87 mmHg,95%CI:-0.96^-0.78,P<0.00001).The further analysis showed that the anti-hypertension effect of eplerenone was not as good as that of spirolactone(SBP:WMD=6.40 mmHg,95%CI:5.89-6.91,P<0.00001;DBP:WMD=3.10 mmHg,95%CI:2.75~3.45,P<0.00001)and enalapril(SBP:WMD=0.70 mmHg,95%CI:0.05~1.35,P=0.03;DBP:WMD=1.43 mmHg,95%CI:1.05~1.80,P<0.00001),and was better than that of angiotensin receptor blockers(SBP:WMD=-6.13 mmHg,95%CI:-6.33^-5.94,P<0.00001,DBP:WMD=-3.19 mmHg,95%CI:-3.31^-3.07,P<0.00001).The anti-hypertension effect of eplerenone was better than that of amlodipine on SBP(WMD=-0.40 mmHg,95%CI:-0.66^-0.14,P=0.003)and was not as good as that of amlodipine on SBP(WMD=2.40 mmHg,95%CI:2.23~2.57,P<0.00001).The difference in total adverse reactions and serious adverse reactions had no statistical significance between eplerenone and other anti-hypertension drugs.Conclusion Elerenone is relatively effective and safe in the treatment of essential hypertension.