Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Hypertens Res. 2013 Nov;36(11):959-66. doi: 10.1038/hr.2013.78. Epub 2013 Aug 15.
A previous meta-analysis of a few randomized controlled trials (RCTs) suggests a significant reduction in ambulatory blood pressure (BP) with telmisartan as compared with losartan monotherapy. We performed an updated meta-analysis of RCTs of telmisartan versus losartan therapy for reduction of ambulatory BP in patients with hypertension. MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through July 2012 using PubMed and OVID. Eligible studies were RCTs of telmisartan versus valsartan therapy enrolling individuals with hypertension and reporting ambulatory BP as an outcome. For each study, data regarding changes from baseline in ambulatory (24 h, last 6 h, morning, daytime and nighttime) BP in both the telmisartan and losartan groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Of 34 potentially relevant articles screened initially, 9 reports of RCTs enrolling a total of 2409 patients with hypertension were identified and included. Pooled analysis suggested significant reductions in all of 24-h (MD of systolic/diastolic BP, -2.09/-1.57 mm Hg; 95% CI, -3.39/-2.32 to -0.79/-0.82 mm Hg), last 6-h (-2.96/-2.15 mm Hg; -3.80/-2.72 to -2.13/-1.59 mm Hg), morning (-2.71/-2.37 mm Hg; -3.73/-3.33 to -1.69/-1.41 mm Hg), daytime (-1.74/-1.73 mm Hg; -3.27/-2.84 to -0.20/-0.62 mm Hg) and nighttime BP (-2.70/-2.08 mm Hg; -4.07/-3.24 to -1.33/-0.92 mm Hg) among patients randomized to telmisartan versus losartan therapy. In conclusion, telmisartan therapy appears to reduce ambulatory BP more than losartan therapy in patients with hypertension.
先前的几项随机对照试验（RCT）的荟萃分析表明，与氯沙坦单药治疗相比，替米沙坦可显著降低动态血压（BP）。我们对替米沙坦与氯沙坦治疗高血压患者的动态血压降低的 RCT 进行了更新的荟萃分析。通过 PubMed 和 OVID 使用 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库，检索了截止到 2012 年 7 月的文献。合格的研究是比较替米沙坦与缬沙坦治疗的 RCT，纳入了高血压患者，并将动态血压作为结果进行报告。对于每一项研究，使用来自替米沙坦和氯沙坦组的基线变化数据来生成平均差值（MD）和 95%置信区间（CI）。在最初筛选的 34 篇潜在相关文章中，有 9 篇 RCT 报告纳入了总共 2409 例高血压患者，这些研究被确定并纳入分析。汇总分析表明，24 小时（收缩压/舒张压 MD，-2.09/-1.57mmHg；95%CI，-3.39/-2.32 至-0.79/-0.82mmHg）、最后 6 小时（-2.96/-2.15mmHg；-3.80/-2.72 至-2.13/-1.59mmHg）、早晨（-2.71/-2.37mmHg；-3.73/-3.33 至-1.69/-1.41mmHg）、白天（-1.74/-1.73mmHg；-3.27/-2.84 至-0.20/-0.62mmHg）和夜间 BP（-2.70/-2.08mmHg；-4.07/-3.24 至-1.33/-0.92mmHg）在随机接受替米沙坦与氯沙坦治疗的患者中均有显著降低。总之，替米沙坦治疗似乎比氯沙坦治疗更能降低高血压患者的动态血压。
