Zhong Zhuoyuan, Wang Limin, Wen Xiaojun, Liu Yunyun, Fan Yafei, Liu Zhonglin
Department of Neurology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Department of Neurology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, Guangzhou, China.
Neuropsychiatr Dis Treat. 2017 Nov 7;13:2781-2796. doi: 10.2147/NDT.S141832. eCollection 2017.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) have been commonly prescribed for depression treatment. However, their effects on blood pressure are unclear.
Effects on blood pressure of depressive patients in two groups (SSRIs versus placebo and SSRIs versus SNRIs) were evaluated. A search was conducted for double-blind, randomized controlled trials (RCTs) in PubMed, EMBASE, ISI Web of Science, PsycNET, CCRCT, and DARE (up to March 2017). The outcomes were systolic blood pressure (SBP) changes and diastolic blood pressure (DBP) changes from baseline to endpoint or to a certain period of treatment duration. Weighted mean differences (WMDs) and 95% CIs were calculated and pooled using random effects models. The test and statistics were used to assess heterogeneity. Funnel plots, Begg's test, and Egger's test were used to estimate publication bias.
A total of 23 RCTs involving 13,285 participants were included. Patients on SSRIs showed no significant differences in blood pressure changes compared with placebo. In the group of SSRIs versus SNRIs, overall SBP changes and DBP changes revealed statistical significances (WMD 1.5 mmHg, 95% CI -2.15, -0.84, =4.46, <0.00001 and WMD 1.34 mmHg, 95% CI -1.92, -0.75, =6.18, <0.00001). Subgroup analyses on treatment duration and age further evidenced these findings.
It was established that SSRIs did not affect blood pressure, while SNRIs led to a modest increase in SBP and DBP with statistical significance compared with SSRIs.
选择性5-羟色胺再摄取抑制剂（SSRIs）和5-羟色胺及去甲肾上腺素再摄取抑制剂（SNRIs）已被普遍用于抑郁症治疗。然而，它们对血压的影响尚不清楚。
评估了两组抑郁症患者（SSRIs与安慰剂对比以及SSRIs与SNRIs对比）的血压变化情况。在PubMed、EMBASE、ISI科学网、PsycNET、中国临床试验注册中心（CCRCT）和循证医学数据库（DARE）（截至2017年3月）中检索双盲随机对照试验（RCTs）。观察指标为收缩压（SBP）从基线到终点或到一定治疗时长的变化以及舒张压（DBP）从基线到终点或到一定治疗时长的变化。计算加权平均差（WMDs）和95%可信区间（CIs），并采用随机效应模型进行汇总。运用Q检验和I²统计量评估异质性。采用漏斗图、Begg检验和Egger检验评估发表偏倚。
共纳入23项涉及13285名参与者的RCTs。与安慰剂相比，服用SSRIs的患者血压变化无显著差异。在SSRIs与SNRIs组中，总体SBP变化和DBP变化具有统计学意义（WMD 1.5 mmHg，95% CI -2.15，-0.84，Q = 4.46，P < 0.00001；WMD 1.34 mmHg，95% CI -1.92，-0.75，Q = 6.18，P < 0.00001）。对治疗时长和年龄的亚组分析进一步证实了这些结果。
已证实SSRIs不影响血压，而与SSRIs相比，SNRIs导致SBP和DBP适度升高且具有统计学意义。
