在钙通道阻滞剂（CCB）单药治疗无效后加用血管紧张素受体阻滞剂（ARB）的疗效和安全性的荟萃分析。
Meta-analysis of the efficacy and safety of adding an angiotensin receptor blocker (ARB) to a calcium channel blocker (CCB) following ineffective CCB monotherapy.
作者信息
Ma Jin, Wang Xiao-Yan, Hu Zhi-De, Zhou Zhi-Rui, Schoenhagen Paul, Wang Hao
机构信息
1 Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai 20090, China ; 2 Graduate School, Dalian Medical University, Dalian 116044, China ; 3 Department of Laboratory Medicine, General Hospital of Ji'nan Military Region, Ji'nan 250031, China ; 4 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 5 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 6 Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA.
出版信息
J Thorac Dis. 2015 Dec;7(12):2243-52. doi: 10.3978/j.issn.2072-1439.2015.12.39.
BACKGROUND
We conducted this meta-analysis to systematically review and analyze the clinical benefits of angiotensin receptor blocker (ARB) combined with calcium channel blocker (CCB) following ineffective CCB monotherapy.
METHODS
PubMed was searched for articles published until August 2015. Randomized controlled trials (RCTs) evaluating the clinical benefits of ARB combined with CCB following ineffective CCB monotherapy were included. The primary efficacy endpoint of the studies was normal rate of blood pressure, the secondary efficacy endpoints were the response rate and change in blood pressure from baseline. The safety endpoint of the studies was incidence of adverse events. Differences are expressed as relative risks (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean differences (WMDs) with 95% CIs for continuous outcomes. Heterogeneity across studies was tested by using the I(2) statistic.
RESULTS
Seven RCTs were included and had sample sizes ranging from 185 to 1,183 subjects (total: 3,909 subjects). The pooled analysis showed that the on-target rate of hypertension treatment was significantly higher in the amlodipine + ARB group than in the amlodipine monotherapy group (RR =1.59; 95% CI, 1.31-1.91; P<0.01). The response rate of systolic blood pressure (SBP) (RR =1.28; 95% CI, 1.04-1.58; P<0.01) and diastolic blood pressure (DBP) (RR =1.27; 95% CI, 1.12-1.44; P=0.04) were significantly higher in the amlodipine + ARB group than in the amlodipine monotherapy group. The change in SBP (RR =-3.56; 95% CI, -7.76-0.63; P=0.10) and DBP (RR =-3.03; 95% CI, -6.51-0.45; P=0.09) were higher in hypertensive patients receiving amlodipine + ARB but the difference did not reach statistical significance. ARB + amlodipine treatment carried a lower risk of adverse events relative to amlodipine monotherapy (RR =0.88; 95% CI, 0.80-0.96; P<0.01).
CONCLUSIONS
The results of our meta-analysis demonstrate that adding an ARB to CCB after initial ineffective CCB monotherapy, significantly improved blood pressure control and the percentage of on-target hypertension treatment with significantly reduced incidence of adverse events compared with continued CCB monotherapy.
背景
我们进行了这项荟萃分析，以系统回顾和分析钙通道阻滞剂（CCB）单药治疗无效后，血管紧张素受体阻滞剂（ARB）联合CCB的临床益处。
方法
检索PubMed中截至2015年8月发表的文章。纳入评估CCB单药治疗无效后ARB联合CCB临床益处的随机对照试验（RCT）。研究的主要疗效终点为血压达标率，次要疗效终点为缓解率及血压相对于基线的变化。研究的安全性终点为不良事件发生率。对于二分变量结果，差异以相对危险度（RR）及95%置信区间（CI）表示；对于连续变量结果，差异以加权均数差（WMD）及95%CI表示。采用I²统计量检验各研究间的异质性。
结果
纳入7项RCT，样本量为185至1183名受试者（共3909名受试者）。汇总分析显示，氨氯地平+ARB组高血压治疗的达标率显著高于氨氯地平单药治疗组（RR =1.59；95%CI，1.31 - 1.91；P<0.01）。氨氯地平+ARB组收缩压（SBP）的缓解率（RR =1.28；95%CI，1.04 - 1.58；P<0.01）和舒张压（DBP）的缓解率（RR =1.27；95%CI，1.12 - 1.44；P =0.04）显著高于氨氯地平单药治疗组。接受氨氯地平+ARB治疗的高血压患者SBP（RR = - 3.56；95%CI， - 7.76 - 0.63；P =0.10）和DBP（RR = - 3.03；95%CI， - 6.51 - 0.45；P =0.09）的变化更大，但差异未达到统计学意义。与氨氯地平单药治疗相比，ARB+氨氯地平治疗的不良事件风险更低（RR =0.88；95%CI，0.80 - 0.96；P<0.01）。
结论
我们的荟萃分析结果表明，在初始CCB单药治疗无效后加用ARB，与继续CCB单药治疗相比，可显著改善血压控制及高血压治疗的达标率，并显著降低不良事件发生率。
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