沙库巴曲缬沙坦对比血管紧张素受体阻滞药治疗原发性高血压的疗效:网状荟萃分析

Efficacy of sacubitril/valsartan versus angiotensin receptor blockers in the treatment of essential hypertension: a network meta-analysis

目的比较沙库巴曲缬沙坦与其他临床常见的血管紧张素受体阻滞药(ARB)在原发性高血压患者中的降压效果。方法采用网状荟萃分析,计算机检索了PubMed、EMBASE、Cochrane Library、Medline、Medline In-process和中国生物医学文献数据库,检索时间截至2020年10月20日,纳入比较沙库巴曲缬沙坦或其他临床常见的ARB或安慰剂治疗原发性高血压的随机对照试验。观察结局主要包括治疗8周后诊室坐位收缩压和舒张压的变化以及总体血压达标率。结果共纳入39项研究。与安慰剂相比,沙库巴曲缬沙坦治疗8周后对诊室坐位收缩压降压效果显著[-16.24(95%CI-19.03~-13.49) mm Hg]。概率排序图和累积排序曲线下面积(SUCRA)结果显示,对于诊室坐位收缩压和舒张压、总体血压达标率结局,与ARB相比,沙库巴曲缬沙坦的降压效果最佳(SUCRA分别为91.39%,85.06%,91.26%)。结论对于原发性高血压患者,沙库巴曲缬沙坦降压效果优于其他临床常见的ARB。

Objective To compare the efficacy of sacubitril/valsartan with commonly-used angiotensin receptor blockers(ARBs) in the treatment of essential hypertension. Methods In this Bayesian network meta-analysis, Pubmed, EMBASE, Cochrane Library, Medline, Medline In-process and Chinese BioMedical Literature Database were electronically retrieved till October 20 th 2020. Randomized controlled trials investigating the efficacy of sacubitril/valsartan or commonly-used ARBs or placebos in essential hypertension patients were included. The changes of office systolic and diastolic blood pressure, and control rate of overall blood pressure after 8-week medication were compared. Results A total of 39 trials were included. Comparing with placebo, sacubitril/valsartan caused a significant reduction in office systolic blood pressure [-16.24(95% confidence interval-19.03 to-13.49) mm Hg] after 8 weeks. The results of rankograms and surface under the cumulative ranking(SUCRA) curve demonstrated that comparing with ARBs, sacubitril/valsartan was the optimal antihypertensive regimen for office systolic and diastolic blood pressure, control of overall blood pressure(SUCRA=91.39%, 85.06%, and 91.26% respectively). Conclusion For essential hypertension, sacubatril/valsartan is superior comparing with commonly-used ARBs.