常用及复方降压药与原发性高血压患者体位性低血压风险的关系：一项系统综述和荟萃分析

The relationship of commonly used antihypertensive drugs and compounds with the risk of orthostatic hypotension in patients with essential hypertension: a systematic review and meta-analysis

    摘要
  • 摘要:
    目的  探讨《中国高血压防治指南 (2024 年修订版)》推荐的常用6类降压药及复方降压与体位性低血压（OH）发生风险的关系，并探讨降压药相关OH与主要不良心血管事件（MACEs）的关系。
    方法  本研究系统回顾并荟萃分析了常用单药及复方降压药与OH发生关联的随机对照试验（RCTs）。系统检索了PubMed、Web of Science、Embase、Medline及维普数据库，检索文献发表时间范围为自建库至2025年4月。从符合条件的研究中提取OH发生的OR和HR。考虑到研究间存在变异性，采用固定效应模型进行荟萃分析，计算合并OR及其95%CI。异质性通过I2统计量进行评估。为验证合并结果的稳健性，进行敏感性分析。同时，对探讨药物治疗诱发OH与MACEs关系的文献进行荟萃分析。
    结果 共纳入15项研究，31 269名受试者。总体荟萃分析结果显示，6类降压单药及复方降压药（OR=1.04，95%CI 0.92～1.17），血管紧张素受体-脑啡肽酶抑制剂（ARNI）（OR=1.02，95%CI 0.52～1.98）；肾素-血管紧张素系统（RAS）抑制剂（OR=0.76，95%CI 0.31～1.85）、利尿剂（OR=0.94，95%CI 0.76～1.16）、钙通道阻滞药（CCB）（OR=0.94，95%CI 0.76～1.16）及复方降压药（OR=0.62，95%CI 0.14～2.63）与OH风险无关；而β受体阻滞剂显著增加OH风险（OR=1.74，95%CI 1.26～2.41）。对3项RCTs的荟萃分析结果提示，降压药相关OH可能增加MACEs，但校正异质性后，随机效应模型无统计学意义（HR=1.09，95%CI 0.78～1.53）。
    结论 6类降压单药及复方降压药总体上未显著增加OH的风险，其中β受体阻滞剂增加了OH风险，现有资料没有证据说明指南推荐的降压药相关OH增加MACEs。

     

    Abstract:
    Objective To investigate the relationship of the six commonly used antihypertensive drugs and compound antihypertensive drugs recommended in the 2024 edition of the Chinese Hypertension Guidelines with the risk of orthostatic hypotension (OH), as well as to explore the relationship of antihypertensive drug-related OH with major adverse cardiovascular events (MACEs).
    Methods This study systematically reviewed and meta-analyzed randomized controlled trials (RCTs) examining the association between common monotherapy and combination antihypertensive drugs and the occurrence of OH. A comprehensive search was conducted using PubMed, Web of Science, Embase, Medline, and VIP databases, covering the period from inception to April 2025. OR and HR for OH events were extracted from eligible studies. Due to heterogeneity among studies, a fixed-effect model was used to calculate pooled ORs and 95%CI. Heterogeneity was assessed by the I2 statistic. Sensitivity analyses were conducted to verify the robustness of the results.
    Results A total of 15 studies were included, with 31 269 participants. The overall meta-analysis for the six classes of antihypertensive monotherapies and combination therapies showed no significant association with OH risk (OR=1.04, 95%CI 0.92–1.17). Specifically, angiotensin receptor neprilysin inhibitors (ARNI) (OR=1.02, 95%CI 0.52–1.98), renin-angiotensin system (RAS) inhibitors (OR=0.76 95%CI 0.31–1.85), diuretics (OR=0.94, 95%CI 0.76–1.16), calcium channel blockers (CCB) (OR=0.94, 95%CI 0.76–1.16), and combination antihypertensive drugs (OR=0.62, 95%CI 0.14–2.63) were not significantly associated with OH risk, while β-blockers significantly increased the risk of OH (OR=1.74, 95%CI 1.26–2.41). Meta-analysis of three RCTs suggested that antihypertensive drug-related OH might increase MACEs, while after adjusting for heterogeneity, the random-effects model showed no statistically significant association (HR=1.09, 95%CI 0.78-1.53).
    Conclusions Overall, the six classes of antihypertensive monotherapies and combination therapies do not significantly increase the risk of OH. β-blockers are the primary agents associated with increased OH risk. Current evidence does not support that OH induced by antihypertensive drugs recommended in current guidelines increases the risk of MACEs.

     

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