天麻钩藤饮联用血管紧张素转化酶抑制剂治疗原发性高血压的Meta分析

目的:探究天麻钩藤饮联合血管紧张素转化酶抑制剂(angiotensin-converting enzyme inhibitors,ACEI)治疗原发性高血压的疗效。方法:搜索中国生物医学、中国期刊及万方科技数据库,纳入天麻钩藤饮联合ACEI与单用ACEL治疗原发性高血压的随机对照试验(RCT)文献,用Jadad量表进行质量评分,对临床疗效、血压值及安全性进行Meta分析。结果:共纳入18篇RCT文献,仅有1篇文献的Jadad评分为3分,其余均小于3分;天麻钩藤饮联合ACEI临床疗效的合并RR值为[1.18,95%CI(1.12,1.24)](P<0.05);治疗后收缩压、舒张压的合并效应量加权均数差依次为[-4.78,95%CI(-8.35,-1.21)],[-4.32,95%CI(-6.34,-2.30)]。联合用药后没有增加不良反应。结论:对比单纯使用西药,天麻钩藤饮联合ACEI治疗高血压病有更好的临床疗效,能降低患者的收缩压和舒张压,没有增加不良反应,适合临床的推广使用。但由于纳入的文献质量不高,需要进一步开展高质量的大样本双盲随机对照试验。

Meta-analysis of Tianma Gouteng Decoction Combined with Angiotensin-converting Enzyme Inhibitors for Treating Primary Hypertension

Objective: To evaluate the effectiveness and safety of Tianma Gouteng Decoction (TGD) combined with angiotensin-converting enzyme inhibitors (ACEI) in treating patients with primary hypertension. Method: Systematic literature searches were performed in Chinese biomedical, China National Knowledge Infrastructure (CNKI) and Wanfang database. Randomised control trials (RCT) about TGD combined with ACEI in treating patients with primary hypertension were enrolled. The quality of the RCT were assessed using Jadad scores. The effectiveness (clinical effect, blood pressure) and safety were evaluated using meta-analysis. Result: A total of 18 articles were included. Only one article scored 3 according to the Jadad, and the others scored less than 3.Compared with ACEI, TGD combined with ACEI had significant higher clinical efficacy [RR=1.18, 95% CI (1.12, 1.24)]. After treatment, weighted mean difference of systolic blood pressure and diastolic blood pressure were [-4.78, 95%CI (-8.35, -1.21)], and [-4.32 95%CI(-6.34,-2.30)], respectively. TGD combined with ACEI did not increase the risks for side effect. Conclusion: TGD combined with ACEI has good effectiveness, and there was no increase in the side effect. Therefore, it is recommended in clinical practice. However, it is necessary to carry out high-quality double-blinded RCT with large sample size.