不同ACEI药物治疗高血压干咳不良事件的网络Meta分析

Adverse events of dry cough on different ACEI drugs for hypertension:A network Meta-analysis

目的利用网络Meta分析系统评价咪达普利及其他血管紧张素转换酶抑制剂(ACEI)类药物治疗高血压降压总有效率及干咳不良事件发生率。方法检索至2023年6月30日前在PubMed、EMBASE、Cochrane Library、中国知网、维普、万方数据库国内外公开发表的使用咪达普利片等ACEI类药物治疗原发性或肾实质性高血压的随机对照试验(RCTs)文献。采用STATA 14.0软件进行网络Meta分析,评价不同ACEI药物治疗高血压干咳不良事件发生率和降压总有效率,效应指标以比值比(OR)及95%置信区间(CI)表示。结果本研究共纳入15项RCTs,共2545例研究对象,包含咪达普利、贝那普利、卡托普利、培哚普利、依那普利、西拉普利6种不同ACEI药物。9项研究报告了降压总有效率,与卡托普利治疗高血压相比,咪达普利(OR=2.09,95%CI:1.36~3.22)降压治疗总有效率高;而其余药物间降压总有效率差异无统计学意义。15项研究报告了干咳不良事件发生率,与依那普利(OR=2.74,95%CI:1.68~4.47)、西拉普利(OR=2.55,95%CI:1.38~4.74)、卡托普利(OR=2.68,95%CI:1.74~4.15)、贝那普利(OR=3.14,95%CI:2.07~4.75)相比,咪达普利干咳不良事件发生率较低;与贝那普利相比,培哚普利治疗干咳不良事件发生率较低(OR=0.40,95%CI:0.16~0.96)。降压总有效率累积概率从高到低排序依次为咪达普利、培哚普利、西拉普利、卡托普利、依那普利、贝那普利。结论在采用ACEI药物治疗高血压时,可考虑选择咪达普利,亟待更大样本多中心RCTs研究进一步证实。

Objective The total effective rate of midazolam and other angiotensin converting enzyme inhibitors(ACEI)in the treatment of hypertension and the incidence of dry cough were evaluated by network meta-analysis system.Methods To retrieve the literatures of randomized controlled trials(RCTs)published at home and abroad in PubMed,EMBASE,Cochrane Library,China Knowledge Network,VIP and Wanfang Database before June 30,2023,using ACEI drugs such as midazolam tablets to treat primary or renal parenchymal hypertension.The network meta-analysis was carried out by STATA 14.0 software to evaluate the incidence of adverse events and the total effective rate of hypertension with dry cough treated by different ACEI drugs.The effect indexes were expressed by ratio(OR)and 95%confidence interval(CI).Results In this study,15 RCTs were included,with a total of 2545 subjects,including 6 different ACEI drugs:midazolam,benazepril,captopril,perindopril,enalapril and cilazapril.Nine studies reported the total effective rate of lowering blood pressure.Compared with captopril in the treatment of hypertension,midazolam(OR=2.09,95%CI:1.36~3.22)showed the total effective rate.However,there was no significant difference in the total effective rate of blood pressure among other drugs.Fifteen studies reported the incidence of adverse events of dry cough,which was compared with enalapril(OR=2.74,95%CI:1.68~4.47),cilazapril(OR=2.55,95%CI:1.38~4.74),captopril(OR=2.68,95%)CI:Compared with benazepril(OR=3.14,95%CI:2.07~4.75),the incidence of dry cough of midazolam was lower.Compared with benazepril,the incidence of adverse events of perindopril in the treatment of dry cough was lower(OR=0.40,95%CI:0.16~0.96).The order of cumulative probability from high to low is midazolam,perindopril,cilazapril,captopril,enalapril and benazepril.Conclusion Clinical decision makers suggest that midazolam should be the first choice when ACEI is used to treat hypertension,but it still needs to be further confirmed by a larger sample multi-center RCTs study.