培哚普利治疗高血压的卫生技术评估  

Health Technology Assessment of Perindopril for Treatment of Hypertension

作　　者：文程[1,2] 易湛苗 门鹏[1,3] 翟所迪 Wen Cheng;Yi Zhanmiao;Men Peng;Zhai Suodi(Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Department of Pharmacy Administration and Clinical Pharmacy,School of Pharmaceutical Sciences,Peking University;Institute for Drug Evaluation,Peking University Health Science Center)

机构地区：[1]北京大学第三医院药剂科,北京100191 [2]北京大学药学院药事管理与临床药学系 [3]北京大学医学部药物评价中心

出　　处：《药物流行病学杂志》2018年第9期565-572,593,共9页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:比较培哚普利与血管紧张素Ⅱ受体拮抗药(ARB)治疗高血压的有效性、安全性和经济性,为临床治疗和决策者提供循证依据。方法:系统检索Pub Med、Embase、Cochrane Library、中国学术期刊网络出版总库(CAJD)、中国生物医学文献数据库(Sino Med)等数据库和卫生技术评估(HTA)相关网站,根据纳入和排除标准筛选文献、提取数据和评价质量后,对研究结果进行定性分析和定量分析。结果:共纳入1篇Meta分析和41项随机对照试验研究。培哚普利与坎地沙坦相比,降压有效率差异无统计学意义(P>0.05),而降低收缩压和舒张压能力均较弱(P<0.05)。培哚普利与与其他ARB类药相比,差异均无统计学意义(P>0.05);培哚普利与氯沙坦相比,在降低左室重量指数、左心室后壁厚度和虚弱等方面差异无统计学意义(P>0.05)。培哚普利与ARB类药相比增加咳嗽的发生率5.3%~10.1%,但在完全规范高血压管理的情况下,全国范围内每年可节约医疗成本(9.13~10.2)亿元。结论:培哚普利用于高血压的治疗具有良好的有效性和经济性,但增加咳嗽的发生率。为节省医疗成本,建议优先选用血管紧张素转化酶抑制药。Objective： To systematically review the efficacy,safety and economy of perindopril versus angiotensin receptor blockers（ ARB） in the treatment of hypertension. Methods： Pub Med,Embase,Cochrane Library,Clinical Trials.gov,CAJD,CDFD,CMFD,Sino Med and HTA websites were searched to evaluate the comparative effects of perindopril versus ARB in patients with hypertension. Results： 1 Meta analysis and 41 RCTs were included. Pooling of RCTs showed,perindopril had a weaker systolic blood pressure（SBP） reduction and diastolic blood pressure（DBP） reduction than candesartan（ P﹤0.05）. Perindopril also showed a high risk of cough（ 5.3%-10.1%） than ARBs. There was no statistical difference in SBP reduction,antihypertensive effective rate,DBP reduction,left ventricular mass index reduction,left ventricular posterior wall thickness reduction between perindopril and other ARBs（ P〉0. 05）. Perindopril is more economical than ARBs. In specific management of hypertension,China medical cost could save（ 913-1 020） million yuan. Conclusion： Perindopril provides a similar BP control to ARBs（ irbesartan,losartan,telmisartan and valsartan）,gets more cough adverse events and has favorable economic efficiency in hypertensive patients. To save medical spending,it proposed to use ACEI drugs in preference.

关 键 词：培哚普利 高血压 有效性 安全性 经济性 卫生技术评估 

分 类 号：R972.4[医药卫生—药品]