不同降压药对绝经后轻中度高血压患者降压疗效的网状荟萃分析

The effects of different antihypertensive drugs on postmenopausal mild to moderate hypertension: a network meta-analysis

  • 摘要: 目的评价不同降压药对绝经后女性高血压患者的降压疗效。方法计算机检索了PubMed、EMBASE、Cochrane Library、ClinicalTrails、中国知网(CNKI)和万方数据库、维普数据库,检索时限均为建库到2020年4月,纳入比较两种或两种以上降压药或安慰剂对绝经后女性高血压患者的疗效的研究。比较结果主要包括收缩压和舒张压的变化。由2位评价员独立筛选文献、提取资料,采用Cochrane"偏倚风险"方法评价随机对照试验方法学质量,运用Stata15软件进行网状荟萃分析。结果本项荟萃分析涉及8项研究。与安慰剂相比,血管紧张素受体阻滞药(ARB)对收缩压的降压效果最显著(均数差=-9.25,95%CI-12.24~-6.26);累积排序曲线下面积(SUCRA)表明ARB(SUCRA=76.3%)和利尿剂(SUCRA=72.4%)降压效果最佳。利尿剂对舒张压效果最佳(均数差=-11.98,95%CI-14.42~-0.95);SUCRA表明利尿剂累积概率最高(SUCRA=94.9%)。结论对于绝经后女性轻中度高血压患者,ARB对收缩压的疗效更好,而利尿剂对舒张压的效果更佳。

     

    Abstract: Objective To compare the effects of different antihypertensive drugs on the reduction of blood pressure in postmenopausal women with hypertension. Methods PubMed, EMBASE, Cochrane Library, ClinicalTrails, WanFang, VIP and CNKI databases were electronically retrieved. The retrieval time limit was from the establishment of the database to April 2020. The efficacy of two or more antihypertensive agents or placebos in postmenopausal hypertensive females was investigated. Mainly, the changes of systolic and diastolic blood pressure were compared. Two reviewers independently screened the literature and extracted the data. Cochrane’s "risk of bias" method was used to evaluate the methodological quality of randomized controlled trials. And network meta-analysis was performed by Stata15.0 software. Results Eight studies were involved in this meta-analysis. Angiotensin receptor blockers(ARB) showed the most significant antihypertensive effects on systolic blood pressure as compared with placebo standardized mean differences(SMD)=-9.25, 95% credibility intervals(CI)-12.24 to-6.26. Surface under the cumulative ranking(SUCRA) suggested ARB(SUCRA=76.3%)and diuretics(SUCRA=72.4%) was the cumulative probability of the best treatment. Diuretics showed the best effect on diastolic blood pressure(SMD=-11.98, 95% CI-14.42 to-0.95) and its cumulative probability was the highest(SUCRA=94.9%). Conclusion For postmenopausal female with hypertension, ARB was optimal on systolic blood pressure while diuretics was optimal on diastolic blood pressure among the different antihypertensive drugs.

     

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