血管紧张素Ⅱ受体拮抗剂治疗高血压的系统评价再评价

Re-evaluation of systematic reviews on the treatment of hypertension with angiotensinⅡreceptor antagonists

目的对氯沙坦、缬沙坦、替米沙坦、坎地沙坦、厄贝沙坦5种血管紧张素Ⅱ受体拮抗剂治疗高血压的系统评价/meta分析进行再评价。方法检索中国知网、万方数据知识服务平台、PudMed、Embase、the Cochrane Library中自数据库建库至2023年4月发表的使用氯沙坦、缬沙坦、替米沙坦、坎地沙坦、厄贝沙坦治疗高血压的系统评价/meta分析。进行文献筛选、提取资料,并采用PRISMA声明、AMSTAR-2量表、GRADE系统对纳入文献的报告、方法学及证据质量进行评价。对文献的报告、方法学和证据质量评价的结果进行分析,并对文献的结果及结论进行描述性分析。结果共纳入15篇文献。PRISMA声明评价结果显示有9篇文献报告相对完整,6篇报告有一定缺陷。AMSTAR 2量表评估结果显示,7篇为低质量研究,7篇为极低质量研究,仅1篇为高质量研究。GRADE系统评价结果显示,共纳入28个结局指标中,高质量指标6个,中等质量指标13个,低质量指标7个,极低质量指标2个。各结局指标定量结果综合分析显示,使用替米沙坦降低患者的基线血压水平、24 h动态血压水平优于其他药物,在不良反应事件上,这几种药物也没有明显的差异。结论替米沙坦在降血压的疗效上体现了一定的优势,这5种药品的相关不良反应事件无明显差异。但是,这些研究质量偏低,在未来研究中需加强规范性。

Objective To re-evaluate the systematic reviews/meta-analyses of the efficacy of five angiotensin II receptor antagonists,including losartan,valsartan,telmisartan,candesartan,and irbesartan,in treating hypertension.Methods A sys⁃tematic search of Chinese National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform,PubMed,Embase,and the Cochrane Library was conducted up to April 2023 for meta-analyses/systematic reviews on the use of losar⁃tan,valsartan,telmisartan,candesartan,and irbesartan in treating hypertension.Literature screening and data extraction were performed,and the reporting,methodology,and evidence quality were assessed using the PRISMA statement,AMSTAR-2 scale,and GRADE system.The results of the evaluation of reporting,methodology,and evidence quality were analyzed,and the findings and conclusions of the literature were descriptively analyzed.Results A total of 15 articles were included.Evalua⁃tion according to the PRISMA statement revealed that 9 articles had relatively complete reporting,while 6 articles had some de⁃ficiencies.According to the AMSTAR-2 assessment,7 studies were of low quality,7 were of very low quality,and only 1 was of high quality.Evaluation using the GRADE system showed that among the 28 included outcome indicators,6 were of high quality,13 were of moderate quality,7 were of low quality,and 2 were of very low quality.A comprehensive analysis of quantitative results for each outcome measure showed that telmisartan was superior in reducing baseline blood pressure levels and 24 hour ambulatory blood pressure levels compared to other drugs,with no significant differences in adverse reaction events.Conclusion Telmisartan demonstrates some advantages in lowering blood pressure efficacy,and there were no signifi⁃cant differences in the related adverse reactions among these 5 drugs.However,the quality of the studies included in this anal⁃ysis was generally low,indicating the need for more standardized approaches in future research.