Wang Zerong, Wang Shixiong, Zhang Liqiong, Wang Jiaxuan, Wang Rong, Chen Shude, Shi Qiling, Wu Hongye, Wang Liuyang, Li Ningyin
The Second Clinical Medical College, Lanzhou University, 730000 Lanzhou, Gansu, China.
Department of Cardiac Surgery, Lanzhou University Second Hospital, 730030 Lanzhou, Gansu, China.
Rev Cardiovasc Med. 2023 Jun 29;24(7):187. doi: 10.31083/j.rcm2407187. eCollection 2023 Jul.
The incidence of hypertension and clinical complications (e.g., heart, cerebrovascular and kidney injury) is increasing worldwide. It is widely known that a relatively large dose of valsartan (320 mg) could alleviate clinical complications. The current network meta-analysis assessed which drug could be combined with a relatively large dose of valsartan to control blood pressure (BP) more effectively. And which combination therapy with different dosages of valsartan did not induce excessive BP reduction with increasing dosages of valsartan.
The PubMed, Embase, Medline, Cochrane Library, CNKI, Wanfang, and CSTJ databases were searched from inception to October 2022 for relevant randomized controlled trials (RCTs). The search strategies included concepts related to hypertension and two-drug combination therapy of different doses of valsartan, and there were no language or data restrictions. The outcomes included adverse effects and changes in systolic BP and diastolic BP. Permanent discontinuations related to treatment were the most accurate and objective measure of adverse effects. The common adverse effects of most studies (i.e., dizziness, headache, nasopharyngitis, asthenia and urticaria) were also included. A Bayesian network meta-analysis was performed, and mean differences with 95% confidence intervals were calculated. ADDIS and STATA were used for Bayesian model network meta-calculation.
Thirty-four RCTs were included involving 26,752 patients, and the interventions included different doses of valsartan combined with various types and doses of drugs. Among many combination therapies, the combination of valsartan 320 mg with amlodipine 10 mg ( 0.01) had the best antihypertensive effect without significant adverse effects. Compared with valsartan 80 mg and 160 mg, valsartan 320 mg combined with hydrochlorothiazide 25 mg ( 0.05) did not further reduce BP and was not shown to increase the incidence of adverse effects.
Combination therapy with a relatively large dose of valsartan could control BP and improve clinical complications effectively. However, for hypertensive patients with different treatment requirements, specific choices should be made regarding whether to control BP, treat clinical complications, or both.
全球范围内，高血压及临床并发症（如心脏、脑血管和肾脏损伤）的发病率正在上升。众所周知，相对大剂量的缬沙坦（320毫克）可缓解临床并发症。当前的网络荟萃分析评估了哪种药物可与相对大剂量的缬沙坦联合使用，以更有效地控制血压（BP）。以及不同剂量缬沙坦的哪种联合治疗不会随着缬沙坦剂量增加而导致血压过度降低。
检索了PubMed、Embase、Medline、Cochrane图书馆、中国知网、万方和维普数据库，从建库至2022年10月，查找相关随机对照试验（RCT）。检索策略包括与高血压以及不同剂量缬沙坦的两药联合治疗相关的概念，且无语言或数据限制。结局包括不良反应以及收缩压和舒张压的变化。与治疗相关的永久停药是不良反应最准确和客观的衡量标准。还纳入了大多数研究的常见不良反应（即头晕、头痛、鼻咽炎、乏力和荨麻疹）。进行了贝叶斯网络荟萃分析，并计算了95%置信区间的平均差异。使用ADDIS和STATA进行贝叶斯模型网络荟萃计算。
纳入34项RCT，涉及26752例患者，干预措施包括不同剂量的缬沙坦与各种类型和剂量的药物联合使用。在众多联合治疗中，320毫克缬沙坦与10毫克氨氯地平联合使用（P<0.01）具有最佳降压效果，且无明显不良反应。与80毫克和160毫克缬沙坦相比，320毫克缬沙坦与25毫克氢氯噻嗪联合使用（P<0.05）并未进一步降低血压，也未显示增加不良反应的发生率。
相对大剂量缬沙坦的联合治疗可有效控制血压并改善临床并发症。然而，对于有不同治疗需求的高血压患者，应就控制血压、治疗临床并发症或两者兼顾做出具体选择。
