Ramadhan Roy N, Rampengan Derren Dch, Puling Imke Mdr, Willyanto Sebastian E, Tjandra Kevin C, Thaha Mochammad, Multazam Chaq Ecz, Suryantoro Satriyo D
Undergraduate Program of Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Undergraduate Program of Medicine, Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia.
Narra J. 2024 Dec;4(3):e1247. doi: 10.52225/narra.v4i3.1247. Epub 2024 Nov 22.
Dysregulation of renin-angiotensin-aldosterone system (RAAS) often leads to hypertension and severe cardiorenal complications. Although RAAS-targeted therapies have proven effective, it remains yet optimal in reducing cardiovascular events. The aim of this study was to evaluate the efficacy and safety of angiotensin receptor neprilysin inhibitor (ARNI) compared to control in patients with hypertension. The primary outcomes were systolic and diastolic blood pressure (BP) control, along with the incidence of adverse events. A systematic review and meta-analysis was conducted according following PRISMA guidelines. A comprehensive literature search was performed across five databases: PubMed, ScienceDirect, EBSCO, Cochrane, and ProQuest, with studies identified up until October 3, 2024. The study included nine clinical trials that met the predefined eligibility criteria: (1) randomized clinical trials; (2) adult patients diagnosed with hypertension; and (3) comparison of ARNI versus control, reporting either BP control or adverse events. Quality appraisal using RoB 2.0 revealed that eight studies had a low risk of bias, and one had a high risk of bias. The pooled analysis demonstrated that ARNI is significantly more efficacious in achieving targeted systolic BP as compared to the control group (OR: 1.80; 95%CI: 1.41 - 2.30; < 0.001; =0%), and there was no statistical difference for the efficacy on diastolic BP compared to control (OR: 0.92; 95%CI: 0.75- 1.13; = 0.45; =75%). The incidence of adverse events was not associated with ARNI (OR: 1.07; 95%CI: 0.90-1.27; = 0.46; =72%). In conclusion, ARNI demonstrated a favorable outcome only in systolic BP, but in diastolic BP which could be associated with inadequate duration of observation. Further studies are warranted to assess BP-lowering effect and safety profile of ARNI in a longer observation time.
肾素-血管紧张素-醛固酮系统（RAAS）失调常导致高血压及严重的心肾并发症。尽管以RAAS为靶点的治疗已被证明有效，但在降低心血管事件方面仍未达到最佳效果。本研究旨在评估血管紧张素受体脑啡肽酶抑制剂（ARNI）对比对照组治疗高血压患者的疗效和安全性。主要结局指标为收缩压和舒张压（BP）控制情况以及不良事件的发生率。按照PRISMA指南进行了系统综述和荟萃分析。在五个数据库（PubMed、ScienceDirect、EBSCO、Cochrane和ProQuest）中进行了全面的文献检索，纳入截至2024年10月3日的研究。该研究纳入了九项符合预定义纳入标准的临床试验：（1）随机临床试验；（2）确诊为高血压的成年患者；（3）ARNI与对照组的比较，报告BP控制情况或不良事件。使用RoB 2.0进行的质量评估显示，八项研究的偏倚风险较低，一项研究的偏倚风险较高。汇总分析表明，与对照组相比，ARNI在实现目标收缩压方面显著更有效（OR：1.80；95%CI：1.41 - 2.30；P < 0.001；I² = 0%），而在舒张压疗效方面与对照组相比无统计学差异（OR：0.92；95%CI：0.75 - 1.13；P = 0.45；I² = 75%）。不良事件的发生率与ARNI无关（OR：1.07；95%CI：0.90 - 1.27；P = 0.46；I² = 72%）。总之，ARNI仅在收缩压方面显示出良好结果，但在舒张压方面可能与观察时间不足有关。有必要进行进一步研究以评估ARNI在更长观察时间内的降压效果和安全性。
