摘要
目的系统评价左旋氨氯地平单药治疗原发性高血压的疗效。方法计算机检索Ovid Medline,Ovid Embase,Cochrane library,CNKI,CBM,VIP,Wanfang Data数据库,检索时限均从自建库至2017年11月20日,对纳入的每项研究进行偏倚风险评价,并采用Revman5.3软件进行Meta分析。结果共纳入121个随机对照试验(RCTs),试验组6905例,对照组6880例。左旋氨氯地平收缩压(SBP)降低值优于氨氯地平(MD=5.14,95%CI:3.02,7.26,P<0.00001)、硝苯地平(MD=5.91,95%CI:0.89,10.93,P=0.04)、非洛地平(MD=3.64,95%CI:1.02,6.27,P=0.01)、坎地沙坦(MD=5.66,95%CI:2.04,9.29,P=0.002)、吲达帕胺(MD=3.69,95%CI:1.96,5.41,P<0.0001),与其余各亚组差异无统计学意义。左旋氨氯地平舒张压(DBP)降低值优于氨氯地平(MD=4.07,95%CI:2.33,5.81,P<0.00001)、硝苯地平(MD=3.72,95%CI:0.41,7.02,P=0.03)、非洛地平(MD=3.03,95%CI:0.23,5.84,P=0.03)、吲达帕胺(MD=3.84,95%CI:2.80,4.88,P<0.00001),与其余各亚组差异无统计学意义。贝那普利(MD=-3.84,95%CI:-5.88,-1.80,P=0.0002)DBP降低值优于左旋氨氯地平。左旋氨氯地平总有效率优于氨氯地平(RR=1.11,95%CI:1.07,1.14,P<0.00001)、硝苯地平(RR=1.12,95%CI:1.10,1.15,P<0.00001)、非洛地平(RR=1.05,95%CI:0.97,1.13,P=0.26)、尼群地平(RR=1.25,95%CI:1.11,1.41,P=0.0002),依那普利(RR=1.12,95%CI:1.02,1.22,P=0.01)、咪达普利(RR=1.11,95%CI:1.03,1.28,P=0.01)与其余各亚组差异无统计学意义。结论基于现有临床证据,左旋氨氯地平单药降压效果优于氨氯地平、硝苯地平、非洛地平,与其他降压药相比疗效尚需进一步研究验证。
Objective To systematically evaluate the efficacy of levamlodipin in treating primary hypertension.Methods Databases of OvidMedline,Ovid EMBase,Cochrane Library,CNKI,CBM,VIP and WanFang were searched.The retrieval time was from inception to November 20,2017.A bias risk assessment was performed for each study included,and Revman 5.3 was used for meta-analysis.Results A total of 121 randomized controlled trials(RCTs)were included,including 6905 cases in the experimental group and6880 cases in the control group.The results of meta-analysis showed that levamlodipin was superior to amlodipine(MD=5.14,95%CI:3.02,7.26,P<0.00001),nifedipine(MD=5.91,95%CI:0.89,10.93,P=0.04),felodipine(MD=3.64,95%CI:1.02,6.27,P=0.01),candesartan(MD=5.66,95%CI:2.04,9.29,P=0.002),indapamide(MD=3.69,95%CI:1.96-5.41,P<0.0001)in decreased value of systolic blood pressure(SBP).No significant differences were observed between levamlodipin and other subgroups in decreased value of SBP.Levamlodipin was superior to amlodipine(MD=4.07,95%CI:2.33,5.81,P<0.00001),nifedipine(MD=3.72,95%CI:0.41,7.02,P=0.03),felodipine(MD=3.03,95%CI:0.23,5.84,P=0.03),indapamide(MD=3.84,95%CI:2.80,4.88,P<0.00001)in decreased value of diastolic blood pressure(DBP).No significant differences were observed between levamlodipin and other subgroups in decreased value of DBP.Benazepril(MD=-3.84,95%CI:-5.88,-1.80,P=0.0002)was superior to levamlodipin in decreased value of DBP.Levamlodipin was superior to amlodipine(RR=1.11,95%CI:1.07-1.14,P<0.00001),nifedipine(RR=1.12,95%CI:1.10,1.15,P<0.00001),felodipine(RR=1.05,95%CI:0.97,1.13,P=0.26),nitrendipine(RR=1.25,95%CI:1.11,1.41,P=0.0002),enalapril(RR=1.12,95%CI:1.02,1.22,P=0.01),nitrendipine(RR=1.25,95%CI:1.11,1.41,P=0.0002),enalapril(RR=1.12,95%CI:1.02,1.22,P=0.01),imidapril(RR=1.11,95%CI:1.03,1.28,P=0.01)in total effective rate.No significant differences were observed between levamlodipin and other subgroup in total effective rate.Conclusion According to the current clinical evidence,levamlodipin is superior to amlodipine,nifedipine,and felodipine.Its efficacy needs further research and verification compared with other antihypertensive drugs.
作者
杨甜
蔡旭阳
蒋学华
吴斌
徐珽
YANG Tian;CAI Xuyang;JIANG Xuehua;WU Bin;XU Ting(West China School of Pharmacy,Sichuan University,Chengdu,Sichuan,China 610041;Department of Clinical Pharmacy,West China Hospital of Sichuan University,Chengdu,Sichuan,China 610041)
出处
《中国药业》
CAS
2020年第5期135-138,共4页
China Pharmaceuticals
基金
四川省医学会“施慧达”专项科研课题[SHD12-02]
关键词
左旋氨氯地平
原发性高血压
随机对照试验
系统评价
levamlodipin
primary hypertension
randomized controlled trials
systematic review
