沙库巴曲缬沙坦的降压作用：一项荟萃分析。

Antihypertensive effect of sacubitril/valsartan: a meta-analysis.

作者信息

De Vecchis Renato, Ariano Carmelina, Soreca Silvia

机构信息

Unit of Preventive Cardiology and Rehabilitation, S. Gennaro dei Poveri Hospital, Naples, Italy -

Division of Geriatrics, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.

出版信息

Minerva Cardioangiol. 2019 Jun;67(3):214-222. doi: 10.23736/S0026-4725.19.04869-2. Epub 2019 Mar 18.

DOI:10.23736/S0026-4725.19.04869-2

PMID:30895762

Abstract

INTRODUCTION

The efficacy and safety of sacubitril/valsartan used as an antihypertensive agent has not yet been completely assessed. Thus, to investigate them in elderly hypertensive patients, a meta-analysis has been performed.

EVIDENCE ACQUISITION

The meta-analysis incorporated only randomized controlled trials (RCTs) in which sacubitril/valsartan was compared with a reference drug. The mean reductions in systolic blood pressure (msSBP) and diastolic blood pressure (msDBP) in the sitting position as well as the mean reductions in ambulatory systolic blood pressure (maSBP) and ambulatory diastolic blood pressure (maDBP), were assumed as efficacy endpoints. Adverse events were taken as safety outcomes.

EVIDENCE SYNTHESIS

Five RCTs were included for a total of 1513 patients for analysis. In all studies, the comparator drug was an angiotensin receptor blocker (ARB) - valsartan in two cases and olmesartan in the remaining three cases. Compared with ARBs, there was a significant reduction in msSBP (weight mean difference [WMD] -5.41 mmHg, 95% CI: -7.0 to -3.8; P<0.01), msDBP (WMD=-1.22 mmHg, 95% CI: -2.15 to -0.3; P<0.01), maSBP (WMD=-4.58 mmHg, 95% CI: -5.62 to -3.54; P<0.01) and maDBP (WMD=-2.17 mmHg, 95% CI: - 2.78 to -1.56; P<0.01) in elderly hypertensive patients at 12 weeks.

CONCLUSIONS

Sacubitril/valsartan may reduce arterial pressure more efficaciously than ARBs in elderly hypertensive patients.

摘要

引言

沙库巴曲缬沙坦作为一种抗高血压药物的疗效和安全性尚未得到全面评估。因此，为了在老年高血压患者中对其进行研究，开展了一项荟萃分析。

证据获取

该荟萃分析仅纳入了将沙库巴曲缬沙坦与对照药物进行比较的随机对照试验（RCT）。坐位收缩压（msSBP）和舒张压（msDBP）的平均降低值以及动态收缩压（maSBP）和动态舒张压（maDBP）的平均降低值被视为疗效终点。不良事件被作为安全结局。

证据综合

纳入了5项RCT，共1513例患者进行分析。在所有研究中，对照药物均为血管紧张素受体阻滞剂（ARB）——2例为缬沙坦，其余3例为奥美沙坦。与ARB相比，老年高血压患者在12周时msSBP显著降低（加权均数差[WMD] -5.41 mmHg，95%CI：-7.0至-3.8；P<0.01），msDBP（WMD=-1.22 mmHg，95%CI：-2.15至-0.3；P<0.01），maSBP（WMD=-4.58 mmHg，95%CI：-5.62至-3.54；P<0.01）和maDBP（WMD=-2.7 mmHg，95%CI：-2.78至-1.56；P<0.01）。