赖诺普利与氨氯地平对老年性高血压患者左心室质量及舒张功能影响的Meta分析

目的系统评价赖诺普利与氨氯地平对老年性高血压患者左心室质量及舒张功能的影响。方法计算机检索Cochrane Library、Pubmed、EMBASE、中国学术期刊网络出版总库、中国生物医学文献数据库、维普、万方,从各数据库建库至2012年11月,纳入赖诺普利与氨氯地平治疗老年性高血压的RCT文献,按纳入与排除标准选择文献并评价质量后,用Revman 5.1软件进行Meta分析。结果共纳入4篇随机对照试验,408例患者。Meta分析结果显示:赖诺普利与氨氯地平在减小左室心肌重量指数[MD=-9.79 95%CI(-27.70,8.12),P=0.28]、左室舒张末期内径[MD=0.22 95%CI(-1.57,2.01),P=0.81]、舒张期室间隔厚度[MD=-0.94 95%CI(-3.16,1.27),P=0.40]、左心室后壁厚度[MD=-1.689 5%CI(-4.82,1.45),P=0.29]、左心室质量[MD=-6.64 95%CI(-15.84,2.56),P=0.16]、收缩压[MD=0.42 95%CI(-2.41,3.25),P=0.77]、舒张压[MD=0.80 95%CI(-1.13,2.73),P=0.42]方面的差异无统计学意义。而在增加E/A比值[MD=0.07 95%CI(0.00,0.13),P=0.04]方面,氨氯地平优于赖诺普利。结论赖诺普利与氨氯地平在减少左心室质量,提高舒张功能方面的差异并不明显。但从药品经济学观点考虑,赖诺普利具有更好的成本-效果比。

The meta-analysis of the effects of lisinopril versus amlodipine on left ventricular mass and diastolic function in elderly patients with hypertension

Objective To systematically evaluate the effectiveness and safety of lisinopril and amlodipine on left ventricular mass and diastolic function in elderly patients with hypertension. Methods Cochrane library, PubMed, EMBASE, CNKI, CBM, VIP and WangFang Datebase were selected to search the randomized controlled trials that compared lisinopril with amlodipine in the treatment of hypertension from initiation establishment of database to November, 2012. The quality of the included studies were evaluated according to the predefined inclusion and exclusion criteria and then meta-analysis was conducted by using RevMan 5.1 software. Results A total of 4 randomized controlled trials （408 patients） were included. Meta-analysis results suggested that there were no significant differences in left ventricular mass index（ MD = - 9.79 95% CI - 27.70 to 8.12）, left ventricular end diastolic diameter（ MD = 0. 22 95% CI - l. 57 to 2. 01 ）, interventricular septal thickness （ MD = - 0.94 95% CI - 3. 16 to 1.27 ）, left ventricular posterior wall thickness （ MD = - 1.68 95 % CI - 4.82 to 1.45） ,left ventricular mass （ MD = - 6.64 95 % CI - 15.84 to 2.56）, systolic pressure （ MD = 0.42 95 % CI - 2.41 to 3.25 ） and diastolic pressure（ MD = 0.80 95 % CI - 1.13 to 2.73 ） between lisinopril and amlodipine group. But for E/A （ MD = 0. 07 95% CI 0. 00 to 0. 13 ）, amlodipine was superior to lisinopril. Conclusions The effectiveness of lisinopril and amlodipine on left veutricular mass and diastolic function in elderly patients with hypertensive have no significant difference. But in consideration of the cost,lisinopril has a better cost-effectiveness ratio.