氯沙坦治疗高血压合并糖调节受损的疗效和安全性的系统评价

Systematic Review on Efficacy and Safety of Losartan in the Treatment of Hypertension Combined with Impaired Glucose Regulation

目的:系统评价氯沙坦治疗高血压合并糖调节受损的疗效和安全性,为临床治疗提供循证参考。方法:计算机检索PubMed、the Cochrane Library、Web of Science、Embase、中国生物医学文献数据库、中国知网、维普数据库和万方等数据库,以建库至2021年5月作为时限进行检索,收集氯沙坦治疗高血压伴血糖调节受损的随机对照试验。评价纳入研究的质量,通过RevMan 5.3软件进行Meta分析。结果:共15篇有效文献被纳入,累计1522例患者。Meta分析结果显示,(1)血压方面,氯沙坦降低收缩压和舒张压的效果较氨氯地平更显著,差异均具有统计学意义(P<0.05),与血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻断剂(ARB)类药物的差异无统计学意义(P>0.05);(2)血糖方面,氯沙坦降低空腹血糖、餐后2 h血糖和胰岛素抵抗指数(HOMA-IR)等方面的效果较氨氯地平更显著,差异均有统计学差异(P<0.05),与ACEI或ARB类药物的差异无统计学意义(P>0.05);(3)安全性方面,氯沙坦与氨氯地平、ACEI或ARB类药物的不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:对于高血压合并糖调节受损的患者,氯沙坦降血压和降血糖的效果较氨氯地平更显著,与ACEI或ARB类药物疗效相当,其不良反应发生率与氨氯地平、ACEI或ARB类药物相近。

OBJECTIVE:To systematically evaluate the efficacy and safety of losartan in the treatment of hypertension combined with impaired glucose regulation,so as to provide evidence-based reference for clinical treatment.METHODS:Randomized controlled trials of losartan in the treatment of hypertension combined with impaired glucose regulation were retrieved from PubMed,the Cochrane Library,Web of Science,Embase,CBM,CNKI,VIP and Wanfang Data from base-building to May 2021.Quality of the involved studies were evaluated,and the RevMan5.3 software to used to perform Meta-analysis.RESULTS:A total of 15 valid studies were involved,including 1522 patients.(1)In terms of blood pressure,losartan had more significant effect in reducing systolic and diastolic blood pressure than those of amlodipine,with statistically significant difference(P<0.05),while the difference between angiotensin-converting enzyme inhibitors(ACEI)or angiotensinⅡreceptor blockers(ARB)was not statistically significant(P>0.05).(2)In terms of blood glucose,losartan had more significant effect in reducing fasting blood glucose,2 h postprandial blood glucose and insulin resistance index(HOMA-IR)than those of amlodipine,with statistically significant difference(P<0.05),while the difference between ACEI or ARB was not statistically significant(P>0.05).(3)In terms of safety,there was no statistically significant difference in the incidence of adverse drug reactions between losartan and amlodipine,ACEI or ARB(P>0.05).CONCLUSIONS:For those patients with hypertension combined with impaired glucose regulation,losartan has more significant effect in reducing systolic and diastolic blood pressure than those of amlodipine,which is comparable to ACEI or ARB,while the losartan has similar incidences of adverse drug reactions to amlodipine,ACEI or ARB.