钙离子拮抗剂和肾素-血管紧张素系统阻断剂对高血压动脉僵硬度作用差异的荟萃分析

目的系统评价钙离子拮抗剂和肾素一血管紧张素系统阻断剂在高血压治疗中，动脉僵硬度变化的差异。方法按循证医学的要求，制定相应的纳入、排除标准及其检索策略。通过PubMed、EMBASE、Ovid EMB Reviews、中国期刊全文数据库、中文科技期刊全文数据库、万方数据库检索相关的随机对照临床研究，计算机检索时间从各数据库建库至2012年1月；同时辅助其他检索，纳入经过钙离子拮抗剂和肾素-血管紧张素系统阻断剂治疗原发性高血压患者的随机对照试验．治疗时间至少12周。采用RevMan5．0软件进行统计分析。结果纳入7篇随机对照研究，共计524例高血压患者。荟萃分析结果显示：肾素-血管紧张素系统阻断剂在改善动脉僵硬度方面优于钙离子拮抗剂（均数差=160．15，95％可信区间57．10-263．21），差异有统计学意义。但是在降低收缩压（均数差=-2．94。95％可信区间-4．59-1．29）和舒张压（均数差=-6．63，95％可信区间-9．56-3．70）方面，较钙离子拮抗剂弱，在降低脉压差（均数差=-6．12，95％可信区间-2．3-14．55）方面与钙离子拮抗剂相比无显著性差异。结论肾素-血管紧张素系统阻断剂在改善高血压患者动脉僵硬度方面优于钙离子拮抗剂，该作用与其降压作用无关。

Meta Analysis of the Effects of Calcium Channel Blockers or Renin-Angiotensin System Blockers on Arterial Stiffness in Hypertension

Objective To evaluate the differences of the changes of pulse wave velocity（PWV） of hypertension patients with the treatment of calcium channel blockers or Renin-angiotensin system blockers. Methods Based on the principles of evidence-based medicine, corresponding inclusion and exclusion criteria, along with search strategies were developed. We searched the Ovid EMB Reviews, PubMed, EMBASE, Chinese Biomedical Literature Database, Chinese Scientific Journal Full-text Database, and Chinese Journal Full-text Database up to January 2012 to identify randomized controlled trials comparing the effects of calcium channel blockers with that of Renin-angiotensin system blockers on arterial stiffness of hypertension patients after more than 12 weeks treatment. Analyzed the data by Coehrane Collaboration＇s RevMan 5.0 software. We performed the comparisons of the effects of calcium channel blockers and Renin-angiotensin system blockers on arterial stiffness, systolic blood pressure, diastolic blood pressure and pulse pressure in hypertension patients. Results Seven randomized controlled trials involving 524 patients were included. The results of meta analysis showed that Renin-angiotensin system blockers was better than calcium channel blockers in reducing arterial stiffness （MD=I60.15, 95%CI 57.10-263.21）, but it was weaker than calcium channel blockers in reducing systolic blood pressure （MD=-2.94, 95%CI-4.59- 1.29） and diastolic blood pressure （MD=-6.63, 95%CI-9.56N-3.70）. There is no significant difference in pulse pressure between the two drugs （MD=-6.12,95%CI-2.3-14.55）. Conclusions The effect of Renin-angiotensin system blockers is stronger than that of calcium channel blockers on reducing arterial stiffness in hypertension patients, and was independent of reduction in blond pressure by these drugs.