左旋氨氯地平联合一线降压药治疗高血压疗效的系统评价

目的：系统评价左旋氨氯地平联合一线降压药治疗高血压的疗效，为临床提供循证依据。方法：计算机检索Ovid Medline、EMBase、Cochrane Library、CNKI、CBM、VIP和WanFang Data，检索时限均从建库至2017年12月，对每项纳入研究进行偏倚风险评价，并采用Rev Man 5.3软件进行Meta分析。结果：共纳入147个RCTs，Meta分析结果显示：（1）左旋氨氯地平联合ACEI在SBP降低值SMD=0.92，95% CI（0.79，1.04），P < 0.000 01]，DBP降低值SMD=0.87，95% CI（0.72，1.03），P < 0.000 01]和总有效率RR=1.23，95% CI（1.20，1.26），P < 0.000 01]方面均优于对照组，差异具有统计学意义；（2）左旋氨氯地平联合ARB在SBP降低值SMD=1.29，95% CI（1.10，1.48），P < 0.000 01]，DBP降低值SMD=0.94，95% CI（0.79，1.09），P < 0.000 01]和总有效率RR=1.22，95% CI（1.20，1.25），P < 0.000 01]方面均优于对照组，差异具有统计学意义；（3）左旋氨氯地平联合β受体拮抗剂在SBP降低值SMD=0.88，95% CI（0.39，1.36），P=0.000 5]，DBP降低值SMD=0.80，95% CI（0.35，1.25），P=0.000 5]和总有效率RR=1.18，95% CI（1.12，1.23），P < 0.000 01]方面优于对照组，差异具有统计学意义；（4）左旋氨氯地平联合利尿剂在SBP降低值SMD=1.34，95% CI（0.78，1.90），P < 0.000 01]，DBP降低值SMD=0.72，95% CI（0.20，1.24），P=0.007]方面优于对照组，差异具有统计学意义。结论：基于现有临床证据，左旋氨氯地平联合一线降压药降压效果优于单一用药方案。

Efficacy of levamlodipin combined first-line hypotensor in treatment of hypertension: a systematic review

OBJECTIVE To systematically evaluate the efficacy of levamlodipin combined first-line hypotensor in hypertension patients.METHODS Databases of Ovid Medline, EMBase, Cochrane Library, CNKI, CBM, VIP and WanFang were searched. The retrieval time was from inception to December 2017. Each included study was assessed for methodological quality, then analyzed by Rev Man5.3 software.RESULTS A total of 147 RCTs were included. The results of meta-analysis showed that, levamlodipin-ACEI combination group was superior to control group with significant differences in decreased value of SBPSMD=0.92, 95% CI (0.79, 1.04), P < 0.000 01], DBPSMD=0.87, 95% CI (0.72, 1.03), P < 0.000 01] and total effective rateRR=1.23, 95% CI (1.20, 1.26), P < 0.000 01], while levamlodipin-ARB combination group was superior to control group with significant differences in decreased value of SBPSMD=1.29, 95% CI (1.10,1.48), P < 0.000 01], DBPSMD=0.94, 95% CI (0.79, 1.09), P < 0.000 01] and total effective rateRR=1.22, 95% CI (1.20, 1.25), P < 0.000 01]. Levamlodipin combined beta-blockers were superior to control group in decreased value of SBPSMD=0.88, 95% CI (0.39, 1.36), P=0.000 5], DBPSMD=0.80, 95% CI (0.35, 1.25), P=0.000 5] and total effective rateRR=1.18, 95% CI (1.12, 1.23), P < 0.000 01]. Levamlodipin combined diuretics was superior to control group in decreased value of SBPSMD=1.34, 95% CI (0.78, 1.90), P < 0.000 01], and DBPSMD=0.72, 95% CI (0.20, 1.24), P=0.007].CONCLUSION According to the current clinical evidence, levamlodipin combined first-line hypotensor has advantage over single administration.