School of Public Health, Hainan Medical University, Hainan, China.
The Second Affiliated Hospital of Hainan Medical University, Hainan, China.
Medicine (Baltimore). 2024 Jun 14;103(24):e37856. doi: 10.1097/MD.0000000000037856.
Currently, most studies primarily focus on directly comparing the efficacy and safety of angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers (CCBs), the two major classes of antihypertensive drugs. Moreover, the majority of studies are based on randomized controlled trials and traditional meta-analyses, with few exploring the efficacy and safety comparisons among various members of ACEIs and CCBs.
ACEIs and CCB were searched for in randomized controlled trials in CNKI, Wanfang, VIP, China Biology Medicine Disc (Si-noMed), PubMed, EMbase, and Cochrane Library databases. The search can be conducted till November 2022. Stata software (version 16.0) and R 4.1.3 was used for statistical analysis and graphics plotting, applying mvmeta, gemtc, and its packages. Meta-regression analysis was used to explore the inconsistencies of the studies.
In 73 trials involving 33 different drugs, a total of 9176 hypertensive patients were included in the analysis, with 4623 in the intervention group and 4553 in the control group. The results of the analysis showed that, according to the SUCRA ranking, felodipine (MD = -12.34, 95% CI: -17.8 to -6.82) was the drug most likely to be the best intervention for systolic blood pressure, while nitrendipine (MD = -8.01, 95% CI: -11.71 to -4.18) was the drug most likely to be the best intervention for diastolic blood pressure. Regarding adverse drug reactions, nifedipine (OR = 0.32, 95% CI: 0.14-0.74) was the drug most likely to be the safest.
The research findings indicate that nifedipine is the optimal intervention for reducing systolic blood pressure in hypertensive patients, nitrendipine is the optimal intervention for reducing diastolic blood pressure in hypertensive patients, and felodipine is the optimal intervention for safety.
目前，大多数研究主要集中在直接比较血管紧张素转换酶抑制剂（ACEI）和钙通道阻滞剂（CCB）这两种主要降压药物的疗效和安全性。此外，大多数研究基于随机对照试验和传统的荟萃分析，很少有研究探索 ACEI 和 CCB 各种成员之间的疗效和安全性比较。
在 CNKI、万方、VIP、中国生物医学文献数据库（Si-noMed）、PubMed、EMbase 和 Cochrane 图书馆数据库中搜索 ACEI 和 CCB 的随机对照试验。检索可以进行到 2022 年 11 月。Stata 软件（版本 16.0）和 R 4.1.3 用于统计分析和图形绘制，应用 mvmeta、gemtc 及其包。使用 meta-regression 分析来探索研究之间的不一致性。
在 73 项涉及 33 种不同药物的试验中，共有 9176 名高血压患者纳入分析，干预组 4623 人，对照组 4553 人。分析结果显示，根据 SUCRA 排名，非洛地平（MD=-12.34，95%CI：-17.8 至-6.82）最有可能成为收缩压最佳干预药物，而尼群地平（MD=-8.01，95%CI：-11.71 至-4.18）最有可能成为舒张压最佳干预药物。关于不良反应，硝苯地平（OR=0.32，95%CI：0.14-0.74）最有可能是最安全的药物。
研究结果表明，硝苯地平是高血压患者降低收缩压的最佳干预药物，尼群地平是高血压患者降低舒张压的最佳干预药物，非洛地平是安全性最佳的干预药物。
