他汀类药物对高血压患者降压效应的Meta分析

目的 评价他汀类药物对高血压患者的降压效应.方法 在PubMed、Embase和Cochrane library中检索2012年12月31日之前的所有关于他汀类药物与高血压相关的随机对照试验,按照纳入与排除标准纳入合格文献,采用改良Jadad量表对纳入文献进行质量评价.两位作者独立从文本和表格中提取干预组和对照组治疗前后的收缩压和舒张压值及样本量.运用Review manager 5.0软件分析加权均数差及95%可信区间.结果 符合纳入标准的文献有33篇,共计2915例患者.与对照组相比,他汀类药物治疗组收缩压下降1.52 mmHg95%可信区间（CI）：-2.35～-0.68,P=0.0004],舒张压下降1.02 mmHg（95%CI：-1.70～-0.34,P=0.003）.若基线血压≥140/90 mmHg,他汀类药物组收缩压下降 2.28 mmHg（95%CI：-3.57～-1.00,P=0.0005）,舒张压下降1.87 mmHg（95%CI：-3.12～-0.62,P=0.003）;基线收缩压＜140/90 mmHg,他汀类药物对血压的影响不明显（P均＞0.05）.在不同他汀类药物的亚组分析中,阿托伐他汀可使收缩压下降4.04 mmHg （95%CI：-6.43～-1.65,P=0.00009）,舒张压下降2.67 mmHg（95%CI：-4.32～-1.02,P=0.002）,其他他汀类药物对血压的影响不明显（P均＞0.05）.他汀类药物治疗（3～6）个月时降压效果最明显.结论 他汀类药物可降低高血压患者的收缩压和舒张压,且与基线血压相关,当基线血压高于140/90 mmHg时降压效应显著,以阿托伐他汀的降压效应最为明显,且治疗3～6个月时效果明显.

A Meta-analysis on statins for reducing blood pressure in hypertensive patients

Objective To review the effect of statins for reducing blood pressure in hypertensive patients. Methods All randomized controlled trials （RCTs） about the relationship between statins and hypertension were retrieved from PubMed, Embase and Cochrane Library before Dec. 31, 2012. The qualified literature was chosen according to inclusion and exclusion criterion, and then the quality was reviewed by using modified Jadad scale. The data of systolic blood pressure （SBP）, diastolic blood pressure （DBP） and sample quantity were extracted by two independent authors from texts and tables in intervention group and control group before and after treatment. The weighted mean difference （WMD） and 95% confidnece interval （C/） were analyzed by using Review manager 5.0 software. Results There were 33 RCTs included involved 2915 patients. Compared with control group, SBP was reduced by 1.52 mmHg 95%CI： -2.35-0.68, P=0.0004] and DBP was reduced by 1.02 mmHg （95%CI： -1.70-0.34, P=0.003） in intervention group. When baseline blood pressure was equal to or over 140/90 mmHg, SBP was reduced by 2.28 mmHg （95%CI： -3.57--1.00, P=0.0005）, and DBP was reduced by 1.87 mmHg （95%CI： -3.12--0.62, P=0.003）. When baseline SBP was below 140/90 mmHg, the influence of statins on blood pressure was not significant （all P〉0.05）. The analysis in subgroups of different statins showed that atorvastatin reduced SBP by 4.04 mmHg （95%CI： -6.43--1.65, P=0.00009） and DBP by 2.67 mmHg （95%CI： -4.32--1.02, P=0.002）, and other statins had no significant influence on blood pressure （all P〉0.05）. The effect of statins in reducing blood pressure was the most significant after treatment for 3 to 6 months. Conclusion Statins can reduce SBP and DBP in hypertensive patients, which was correlated to baseline blood pressure. When baseline blood pressure is over 140/90 mmHg, the effect of statines especially atorvastatin in reducing blood pressure is significant and the effect is the most significant after treatment for 3 to 6 months.