Ma Linlin, Zheng Keyang, Yan Jiafu, Cheng Wenli
Department of Hypertension, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Capital Medical University, Beijing, China.
Int J Hypertens. 2021 Apr 27;2021:6670183. doi: 10.1155/2021/6670183. eCollection 2021.
To evaluate the efficacy of combination of angiotensin receptor blocker (ARB) with hydrochlorothiazide (HCTZ) compared to ARB alone in patients with uncontrolled hypertension via a systematic review and meta-analysis.
We searched databases till July 2019 using relevant search terms. We included articles that were randomised controlled trials (RCTs) comparing ARB/HCTZ with ARB for a duration of at least 4 weeks and reported on the efficacy or safety. Meta-analyses for efficacy outcomes were performed. In addition, groups given different concentrations of HCTZ (12.5 and 25 mg) were analysed separately.
Sixteen RCTs (12,055 participants) were included. Overall, ARB/HCTZ combination therapy (both 12.5 and 25 mg HCTZ combination) resulted in better sitting systolic and diastolic blood pressure control than ARB alone (mean difference (95% confidence interval (CI): -5.69 [-6.66, -4.73] for 12.5 mg and -9.10 [-11.78, -6.42] for 25 mg and mean difference (95% CI): -2.91 [-3.31, -2.51] for 12.5 mg and -4.16 [-4.75, -3.58] for 25 mg). ARB/HCTZ combination therapy resulted in a higher rate of target blood pressure achievement compared to ARB alone (risk ratio (95% CI): 1.50 [1.42, 1.59]). ARB/HCTZ combination therapy had similar rates of total adverse events (AEs) and severe AEs compared to ARB alone.
ARB/HCTZ combination therapy is more efficacious for controlling blood pressure, and combination with a low concentration of HCTZ has similar AEs compared to ARB alone. Clinicians should consider adding HCTZ in the medication regime of patients with uncontrolled hypertension using ARB, if their clinical profile allows.
通过系统评价和荟萃分析，评估血管紧张素受体阻滞剂（ARB）与氢氯噻嗪（HCTZ）联合使用相较于单独使用ARB治疗血压控制不佳患者的疗效。
我们使用相关检索词检索了截至2019年7月的数据库。纳入的文章为随机对照试验（RCT），比较了ARB/HCTZ与ARB，疗程至少4周，并报告了疗效或安全性。对疗效结局进行荟萃分析。此外，对给予不同浓度HCTZ（12.5和25mg）的组分别进行分析。
纳入了16项RCT（12,055名参与者）。总体而言，ARB/HCTZ联合治疗（12.5mg和25mg HCTZ联合）在坐位收缩压和舒张压控制方面比单独使用ARB效果更好（12.5mg时平均差值（95%置信区间（CI））：-5.69[-6.66, -4.73]，25mg时为-9.10[-11.78, -6.42]；12.5mg时平均差值（95%CI）：-2.91[-3.31, -2.51]，25mg时为-4.16[-4.75, -3.58]）。与单独使用ARB相比，ARB/HCTZ联合治疗实现目标血压的比例更高（风险比（95%CI）：1.50[1.42, 1.59]）。与单独使用ARB相比，ARB/HCTZ联合治疗的总不良事件（AE）和严重AE发生率相似。
ARB/HCTZ联合治疗在控制血压方面更有效，且与单独使用ARB相比，联合低浓度HCTZ的不良事件相似。如果临床情况允许，临床医生应考虑在使用ARB治疗血压控制不佳的患者的用药方案中添加HCTZ。
