不同剂量沙库巴曲缬沙坦与奥美沙坦治疗原发性高血压的疗效比较：系统评价和荟萃分析。
Different Doses of Sacubitril/Valsartan Compared with Olmesartan in Patients with Essential Hypertension: A Systematic Review and Meta-Analysis.
机构信息
Department of Internal Medicine, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia.
Department of Pharmaceutical Services, Al Kharj Military Hospitals, Al Kharj, Saudi Arabia.
出版信息
High Blood Press Cardiovasc Prev. 2023 May;30(3):207-218. doi: 10.1007/s40292-023-00572-7. Epub 2023 Apr 5.
INTRODUCTION
Since sacubitril/valsartan (LCZ696) has neprilysin inhibition and angiotensin receptor-blocking properties, it is anticipated to have strong antihypertensive effects. However, there is not enough evidence to compare the safety and efficacy of sacubitril/valsartan to those of olmesartan in patients with hypertension.
AIM
To compare the efficacy and safety of sacubitril/valsartan versus olmesartan in patients with hypertension.
METHODS
This study follows the guidelines of the Cochrane Handbook. We searched MEDLINE, Cochrane Central, Scopus, and Web of Science databases for relevant clinical trials. We extracted outcome endpoints regarding mean ambulatory systolic/diastolic blood pressure (maSBP/maDBP), mean sitting systolic/diastolic blood pressure (msSBP/msDBP), mean ambulatory/mean sitting pulse pressure (maPP/msPP), the proportion of patients achieving blood pressure control (< 140/90 mmHg), and adverse events. We used Review Manager Software for the conduction of the analysis of this study. The effect estimates of the studies were pooled as Mean difference or risk ratio and 95% confidence interval. We also conducted a subgroup analysis based on the dose of sacubitril/valsartan.
RESULTS
A total of six clinical trials were included. The studies showed an overall low risk of bias. The pooled effect estimate revealed that sacubitril/valsartan significantly reduces maSBP, maDBP, maPP, msSBP, and msDBP measurements compared with olmesartan (p < 0.001). A significantly higher portion of patients achieved blood pressure control in the sacubitril/valsartan group (p < 0.001). The test of subgroup difference showed that 400 mg dose is significantly more effective than 200 mg dose in reducing maSBP. Regarding the safety profile, olmesartan was associated with more side effects due to drug discontinuation and more serious side effects.
CONCLUSION
Sacubitril/valsartan or LCZ696 is more effective and safer than olmesartan for controlling blood pressure in patients with hypertension.
简介
由于沙库巴曲缬沙坦（LCZ696）具有脑啡肽酶抑制和血管紧张素受体阻断作用，预计它具有较强的降压作用。然而，目前尚无足够的证据比较沙库巴曲缬沙坦与奥美沙坦治疗高血压患者的安全性和疗效。
目的
比较沙库巴曲缬沙坦与奥美沙坦治疗高血压患者的疗效和安全性。
方法
本研究遵循 Cochrane 手册指南。我们检索了 MEDLINE、Cochrane 中心、Scopus 和 Web of Science 数据库中的相关临床试验。我们提取了有关平均动态收缩/舒张压（maSBP/maDBP）、平均坐位收缩/舒张压（msSBP/msDBP）、平均动态/平均坐位脉压（maPP/msPP）、血压控制达标率（<140/90mmHg）和不良事件的结局指标。我们使用 Review Manager 软件进行分析。使用均数差或风险比及其 95%置信区间对研究的效应估计值进行合并。我们还根据沙库巴曲缬沙坦的剂量进行了亚组分析。
结果
共有 6 项临床试验纳入研究。研究显示总体偏倚风险较低。汇总效应估计表明，与奥美沙坦相比，沙库巴曲缬沙坦可显著降低 maSBP、maDBP、maPP、msSBP 和 msDBP 测量值（p<0.001）。沙库巴曲缬沙坦组血压控制达标率显著更高（p<0.001）。亚组差异检验显示，400mg 剂量在降低 maSBP 方面明显优于 200mg 剂量。关于安全性概况，由于药物停药和更严重的副作用，奥美沙坦与更多的副作用相关。
结论
与奥美沙坦相比，沙库巴曲缬沙坦（LCZ696）在控制高血压患者血压方面更有效且更安全。
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