血管紧张素转化酶抑制剂联合血管紧张素Ⅱ受体阻滞剂对原发性高血压左室肥厚逆转作用的系统评价

目的系统评价血管紧张素转化酶抑制剂(ACEI)联合血管紧张素Ⅱ受体阻滞剂(ARB)对高血压左室肥厚逆转作用的有效性和安全性。方法计算机检索Cochrane图书馆、PubMed、Embase、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、中国期刊全文数据库(CNKI),对纳入的随对照试验(RCT)进行质量评价,并用RevMan 5.1软件进行Meta分析。结果共纳入12项研究,进行Meta分析的患者合计835例。结果显示,左心室质量指数(LVMI)改善联合组优于单用ARB组,差异有统计学意义[MD=-14.74,95%CI(-16.71,-12.76),P<0.000 01];平均24 h动态血压(收缩压)组间差异有统计学意义,但无临床意义[MD=-2.33,95%CI(-4.54,-0.12),P=0.04];总不良反应和干咳发生率组间差异均无统计学意义[RR=1.24,95%CI(0.58,2.63),P=0.57]和[RR=7.13,95%CI(0.92,55.54),P=0.06]。结论 ACEI联合ARB对高血压左室肥厚的逆转作用优于单用ARB,且不增加不良反应。但纳入研究整体质量不高,仍须高质量RCT进一步证实。

Systematic Evaluation on Reverse Effects of ACEI and ARB Combination Therapy on Left Ventricular Hypertrophy in Patients with Essential Hypertension

Objective To systematically evaluate the effectivceness and safety of combined angiotensin converting enzyme inhibitor （ACEI） and angiotensin receptor blocker（ARB） on the reverse effect of left ventrieular hypertrophy in the patients with essential hy- pertension. Methods By retrieving the Cochrane library, PubMed, Embase, CBM, VIP, CNKI, the included randomized controlled trails （RCTs） were conducted the quality evaluation and analyzed using RevMan 5. 1 software. Results Twelve studies were included, in which 835 patients were performed the meta analysis. The results showed that the left ventricular mass index（LVMI） in the combination therapy group was superior to the simple ARB group with statistical difference between the two groups [ MD = - 14.74,95% CI（ - 16.71, -12.76）, P〈0. O00 01]; there was significant statistical but not clinical difference for mean 24h ambulatory blood pressure （SBP） [ MD = -2.33,95% CI（- 4.54, -0. 12）, P = 0. 04]. Moreover, the incidence rate of total adverse reactions and dry cough had no sta- tistical difference between the two groups[ RR = 1.24, 95% CI（O. 58, 2.63）, P =0.57; RR =7.13,95% CI（O. 92, 55.54）, P =0.06]. Conclusion Combination of the reverse effect of ACEI and ARB combination on left ventricular hypertrophy is superior to ARB alone without increasing adverse reactions. But the included studies are not of good quality, the high quality RCT should be needed to further confirmation.