盐酸咪达普利治疗高血压以及心力衰竭的荟萃分析

Meta-analysis of midapril hydrochloride in the treatment of hypertension and heart failure

目的系统评价盐酸咪达普利治疗高血压以及心力衰竭的有效性,以期为高血压以及心力衰竭的临床诊疗提供理论基础与参考借鉴。方法利用计算机检索CNKI、VIP、CBM、WanFang Data、PubMed等数据库收集国内外公开发表的使用盐酸咪达普利治疗高血压以及心力衰竭的随机对照试验(RCTs)文献,所有文献由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险。采用固定或随机效应模型汇总研究结果,并使用RevMan 5.4完成荟萃分析,绘制森林图。采用治疗有效率,收缩压降低幅度,舒张压降低幅度,左室舒张末期内径(LVEDd),左室收缩末期内径(LVESd)以及射血分数(LVEF)等指标系统评估盐酸咪达普利治疗高血压以及心力衰竭的有效性。结果①高血压:共纳入9项随机对照试验,包含1491例患者。Meta分析结果显示,盐酸咪达普利与其他抗高血压药物在治疗有效率以及收缩压变化方面差异无统计学意义(P>0.05),但舒张压变化幅度明显优于其他抗高血压药物(P=0.004,MD=0.93,95%CI:0.29~1.57);②心力衰竭:共纳入6项随机对照试验,包含614例患者。Meta分析结果显示,与常规治疗相比,盐酸咪达普利+常规治疗能显著改善心衰患者LVEDd、LVESd以及LVEF(P=0.0002,MD=-2.33,95%CI:-3.56~-1.11;P=0.01,MD=-3.15,95%CI:-5.65~-0.65;P<0.0001,MD=6.16,95%CI:3.74~8.59)。结论对于高血压而言,盐酸咪达普利的治疗有效率及收缩压降低幅度与其他抗高血压类药物相当,但舒张压降低幅度更为明显;对于心衰患者而言,盐酸咪达普利能进一步改善患者心功能。

Objective To systematically review the effectiveness of imidapril hydrochloride in the treatment of hypertension and heart failure,in order to provide a theoretical basis and reference for the clinical diagnosis and treatment of hypertension and heart failure.Methods Randomized controlled trials(RCTs)literatures on the use of midapril hydrochloride in the treatment of hypertension and heart failure were collected from CNKI,VIP,CBM,WanFang Data,PubMed and other databases by computer retrieval.All the literatures were screened independently by two researchers,and the data were extracted to evaluate the risk of bias in the included studies.Results were pooled using fixed or random effects models,and a meta-analysis was completed using RevMan5.4 to map the forest.The efficacy of midapril hydrochloride in the treatment of hypertension and heart failure was evaluated by using therapeutic response rate,systolic blood pressure reduction,diastolic blood pressure reduction,left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd)and left ventricular ejection fraction(LVEF).Results①Hypertension:a total of 9 randomized controlled trials were included,including 1,491 patients.Meta-analysis showed that there was no significant difference between midapril hydrochloride and other antihypertensive drugs in treatment efficiency and systolic blood pressure change(P>0.05),but the range of diastolic blood pressure change was significantly better than other antihypertensive drugs(P=0.004,MD=0.93,95%CI:0.29~1.57).②Heart failure:a total of 6 randomized controlled trials were included,including 614 patients.Meta-analysis showed that midaprilil hydrochloride+conventional treatment significantly improved LVEDd,LVESd,and LVEF in patients with heart failure compared with conventional treatment(P=0.0002,MD=-2.33,95%CI:-3.56~-1.11;P=0.01,MD=-3.15,95%CI:-5.65~-0.65;P<0.0001,MD=6.16,95%CI:3.74~8.59).Conclusion For hypertension,midapril hydrochloride has the same effective rate and decrease of systolic blood pressure as other antihypertensive drugs,but the decrease of diastolic blood pressure is more obvious.For patients with heart failure,midapril hydrochloride can further improve cardiac function.