缬沙坦对比氨氯地平治疗原发性高血压左室肥厚效果的系统评价  

Protective effect of valsartan versus amlodipine on left ventricular hypertrophy in patients with essential hypertension﹕a systematic review

作　　者：江莲[1] 谢波[1] 李一梅[1] 胡乾佩 刘静[1] 韩琳娜[1] 罗天勇[1] 郑泰浩 

机构地区：[1]重庆医科大学附属永川医院全科医学科,永川402160

出　　处：《重庆医科大学学报》2013年第12期1459-1464,共6页Journal of Chongqing Medical University

基　　金：重庆医科大学附属永川医院资助项目(编号:YJYB201008)

摘　　要：目的：系统评价缬沙坦对原发性高血压左室肥厚（1eftventricularhypertrophy，LVH）的有效性及安全性。方法：计算机检索rrheCochraneLibrary、OVID、PubMed、MEDLINE、Embase、CBM、CNKI、维普、万方数据资源（从建库至2012年12月），人工检索相关杂志，使用谷歌学术搜索、百度等互联网上资源，进行引文追踪。按Cochrane协作网推荐的简单评价法，由2名评价者独立评价并交叉核对纳入研究的质量。按照纳入与排除标准选择文献并评价质量后，对同质研究采用RevMan5．2软件进行统计学处理。结果：共检索出文献291篇，经筛选最终纳入7篇随机对照试验（randomizedcontrolledtrials，RCTs），其中中文6篇，英文1篇。Meta分析结果显示：（1）有效率：缬沙坦与氨氯地平相比。两者降低收缩压和舒张压的差异无统计学意义，但逆转高血压LVH的差异有统计学意义（MD=12．10，95％CI=6．61—17．60，P=0．000），显示缬沙坦的效果优于氨氯地平。（2）不良反应发生率：缬沙坦与氨氯地平（OR=0．54，95％CI=0．25-1．16，P=0．120）相比差异无统计学意义，其不良反应发生率相当。结论：本系统评价结果表明．与氨氯地平相比缬沙坦治疗高血压LVH效果更好。由于纳入研究样本量较少、方法学质量较低且缺乏以临床事件为结局指标的试验研究。有必要开展更多高质量、大样本、长期随访的RCTs加以验证。Objective：To evaluate the protective effect and safety of valsartan on left ventricular hypertrophy （LVH） in patients with essential hypertension. Methods ： Database was retrieved including .The Cochrane Library, Ovid, Pubmed, Medline, Embase, CBM, CNKI, VIP and Wan Fang（by the end of December 2012）. Relevant magazines were retrieved manually. Baidu, Google and other re- sources on the internet were used for references. Simple evaluation method was recommended by the Cochrane Collaboration and two reviewers independently evaluated and cross-checked the quality of the included studies. Studies were screened according to prede- fined inclusion and exclusion criteria and the methodological quality was critically evaluated. Data analysis was conducted using RevMan 5.2 software. Results：A total of 291 papers were retrieved,7 （6 Chinese and 1 English papers） randomized controlled trials （RCTs） were finally included. Meta analyses showed that：①effective rate：there was no difference in lowing systolic blood pressure （SBP） and diastolic blood pressure（DBP） between the valsartan group and amlodipine group,however,there were statistical differences in reversing LVH between the valsartan group and amlodipine group with better effect in v alsartan group（MD=12.10,95%CI=6.61 to 17.60, P=0.000）.②incidence of adverse events：there was no significant difference in incidence of adverse events between valsartan group and amlodipine group （0R=0.54,95%CI=0.25 to 1.16, P=0.120）. Conclusions：Valsartan is superior to the amlodipine in the treatment of LVH of hypertension. Because of the small sample,low methodological quality and lack of experimental research on clinical events, it is necessary to conduct more large-scale, high-quality and muhicenter RCTs in the future.

关 键 词：缬沙坦 氨氯地平 左室肥厚 原发性高血压 系统评价 

分 类 号：R544.1[医药卫生—心血管疾病]