60岁以上亚洲老年高血压患者强化降压与标准降压比较的Meta分析

Benefits and risks of more intensive versus less intensive blood pressure control in elderly Asian patients over 60 years old: a meta-analysis

目的 系统评价强化降压与标准降压治疗对60岁以上亚洲老年患者的获益与风险。方法 计算机检索PubMed、EMbase、Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,搜集有关亚洲老年高血压患者强化降压治疗与标准降压治疗的随机对照试验(RCT),检索时限均从建库至2022年8月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 共纳入6个RCT,包括20 701例患者。Meta分析结果显示:强化降压治疗相对于标准降压治疗可以降低患者的心血管死亡、脑卒中、心力衰竭等相关心血管事件的发生风险,但是不能降低全因死亡和心肌梗死的发生风险。亚组分析结果与总体Meta分析结果基本一致,但是收缩压>140 mmHg不能降低心血管死亡事件的发生风险。安全性评价发现强化降压治疗没有增加不良事件和肾脏损伤的发生风险。结论 当前证据显示,强化降压治疗可以降低60岁以上亚洲老年高血压患者心血管死亡、脑卒中、心力衰竭事件的发生,但不能降低全因死亡和心肌梗死事件的发生。强化降压治疗具有很好的安全性。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the benefits and risks of more intensive versus less intensive blood pressure control in Asian elderly patients over 60 years old. Methods The PubMed, EMbase, Cochrane Library,CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials(RCTs) of intensive versus less blood pressure control from inception to August 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 6 RCTs involving 20 701 patients were included. The results of meta-analysis showed that intensive blood pressure control could reduce the incidence of cardiovascular death, stroke, and heart failure. However, it could not reduce the incidence of all-cause death and myocardial infarction. Subgroup analysis showed that systolic blood pressure greater than 140 mmHg could not reduce the incidence of cardiovascular death. The safety evaluation found no increase in adverse events or renal injury in intensive blood pressure control group.Conclusion The current evidence shows that intensive blood pressure control can reduce the incidence of cardiovascular death, stroke and heart failure events in elderly Asian patients over 60 years old, but it has no effect on allcause mortality and myocardial infarction events. It has good safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.