卡维地洛与美托洛尔比较治疗原发性高血压效果的系统评价  

Carvedilol versus Metoprolol for Primary Hypertension:A Systematic Review

作　　者：牛小伟[1,2] 许涵[2,3] 贺生亮[1] 陈德[1] 燕东[1] 何智余[1] 姚亚丽[4] 

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学循证医学中心,兰州730000 [3]兰州大学第二临床医学院,兰州730000 [4]兰州大学第一医院,兰州730000

出　　处：《中国循证医学杂志》2013年第8期963-970,共8页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价卡维地洛与美托洛尔比较治疗原发性高血压的疗效与安全性。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CBM、CNKI、VIP和WanFang Data,检索时限均为从建库至2012年12月。由两名评价者按照纳入与排除标准以及Cochrane协作网推荐的方法独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入7个研究,2 243例患者。Meta分析结果显示:①疗效:卡维地洛与美托洛尔在降低收缩压、舒张压以及心率方面差异无统计学意义(P>0.05);在对甘油三酯[MD=0.75,95%CI(0.45,1.04),P<0.000 01]、胆固醇[MD=0.38,95%CI(0.19,0.56),P<0.000 1]、低密度脂蛋白[MD=0.59,95%CI(0.33,0.85),P<0.000 01]、高密度脂蛋白[MD=–0.09,95%CI(–0.16,–0.02),P=0.008]以及空腹血糖[MD=0.36,95%CI(0.21,0.51),P<0.000 01]的影响方面,卡维地洛明显优于美托洛尔。②安全性:卡维地洛的药物相关性不良反应低于美托洛尔[OR=0.39,95%CI(0.24,0.63),P=0.000 1]。结论本系统评价结果显示,卡维地洛治疗原发性高血压疗效与美托洛尔相当,并能改善患者的血糖、血脂代谢水平,且安全性更好。Objective To systematically review the effectiveness and safety of carvedilol and metoprolol for primary hypertension.Methods Such databases as PubMed,EMbase,Web of Science,The Cochrane Library,CBM,CNKI,VIP and WanFang Data were electronically searched for relevant studies from inception to December,2012.Two reviewers independently screened literature according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration,extracted data,and assessed the methodological quality of the included studies.Then,meta-analysis was performed using RevMan 5.1 software.Results 7 trials involving 2 243 patients were included.The results of meta-analysis showed no significant difference in the reduction of systolic blood pressure,diastolic blood pressure,and heart rate between the carvedilol and metoprolol groups（P0.05）.However,the carvedilol group was superior to the metoprolol group in improving serum triglyceride（MD=0.75,95%CI 0.45 to 1.04,P0.000 01）,serum cholesterol（MD=0.38,95%CI 0.19 to 0.56,P0.000 1）,serum low density lipoprotein（MD=0.59,95%CI 0.33 to 0.85,P0.000 01）,serum high density lipoprotein（MD=-0.09,95%CI -0.16 to -0.02,P=0.008）,and fasting plasma glucose（MD=0.36,95%CI 0.21 to 0.51,P0.000 01）.In addition,the incidence of drug related adverse reaction was significantly lower in the carvedilol group（OR=0.39,95%CI 0.24 to 0.63,P=0.000 1）.Conclusion Based on current evidence,carvedilol tends to have beneficial effects on metabolic parameters and safety profiles,compared with metoprolol.

关 键 词：卡维地洛 美托洛尔 原发性高血压 系统评价 META分析 随机对照试验 

分 类 号：R541.6[医药卫生—心血管疾病]