Zhao Di, Liu Hui, Dong Pingshuan, Zhao Jingdong
Division of Hypertension, the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China.
Division of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang 471000, China.
Int J Cardiol. 2017 Apr 15;233:113-117. doi: 10.1016/j.ijcard.2016.12.158. Epub 2016 Dec 29.
The efficacy of add-on use of spironolactone in patients with resistant hypertension has been investigated in several small studies. We performed this meta-analysis evaluating the efficacy of add-on use of spironolactone in these patients.
We searched Pubmed, Web of Science, and Cochrane Central for all published studies evaluating add-on use of spironolactone in patients with resistant hypertension. Only randomized controlled trials determining antihypertensive effects of spironolactone were considered.
The antihypertensive effects were assessed in 869 patients included in 4 trials with a mean follow-up of 12±3weeks. The reduction of systolic blood pressure (SBP) and diastolic BP (DBP) in patients treated with spironolactone was greater than placebo (weighted mean differences (WMD) for SBP -16.67mmHg (95% confidence interval (CI), -27.54, -5.80), p<0.01; WMD for DBP -6.11mmHg (95% CI, -9.34, -2.88), p<0.001), respectively. The rates of serious adverse effects or patient withdrawals from the trials tended to be higher in patients treated with spironolactone than placebo (WMD for odds ratio 2.11 (95% CI, 0.98, 4.53), p=0.05).
This meta-analysis provides the evidence that add-on use of spironolactone in patients with resistant hypertension is effective in lowering SBP and DBP, suggesting an add-on use of spironolactone as fourth line therapy in patients with resistant hypertension.
在几项小型研究中已对加用螺内酯治疗顽固性高血压患者的疗效进行了调查。我们进行了这项荟萃分析，以评估加用螺内酯治疗这些患者的疗效。
我们在PubMed、科学网和考克兰中央对照试验注册库中检索了所有已发表的评估加用螺内酯治疗顽固性高血压患者的研究。仅纳入确定螺内酯降压效果的随机对照试验。
4项试验共纳入869例患者评估降压效果，平均随访时间为12±3周。接受螺内酯治疗的患者收缩压（SBP）和舒张压（DBP）的降低幅度大于安慰剂组（SBP加权平均差（WMD）为-16.67mmHg（95%置信区间（CI），-27.54，-5.80），p<0.01；DBP 的WMD为-6.11mmHg（95%CI，-9.34，-2.88），p<0.001）。接受螺内酯治疗的患者严重不良反应发生率或退出试验的比例往往高于安慰剂组（优势比的WMD为2.11（95%CI，0.98，4.53），p=0.05）。
这项荟萃分析提供了证据，表明加用螺内酯治疗顽固性高血压患者可有效降低收缩压和舒张压，提示加用螺内酯可作为顽固性高血压患者的四线治疗方案。
