他汀类药物治疗血脂正常单纯收缩期高血压患者的疗效及安全性的Meta分析
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摘要
目的:系统评价他汀类药物治疗血脂正常单纯性收缩期高血压患者(ISH)的疗效及安全性。方法:计算机检索Pubmed、EMbase、Cochrane图书馆临床对照试验资料库、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)和万方数据库及万方中华医学会期刊库,检索时间均从建库至2012年5月,手工检索相关文献。收集他汀类药物治疗血脂正常ISH患者的随机对照试验(RCT)。对符合纳入标准的临床研究进行质量评价和资料提取后,采用RevMan5.0软件进行Meta分析。结果:共纳入17项RCT,包括1297例患者。Meta分析结果显示,试验组较对照组能有效地降低收缩压(SBP)[MD=-4.56,95%CI(-5.60,-3.53),P<0.00001],防止舒张压(DBP)的过度降低[MD=3.26,95%CI(1.42,5.09),P=0.0005],还能有效地缩小脉压差(PP)[MD=-8.41,95%CI(-10.44,-6.38),P<0.00001]。试验组对总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和不良反应发生率的影响与对照组比较,差异无统计学意义。结论:对于血脂正常的ISH患者,他汀类药物能有效地降低SBP,缩小PP,不良反应发生率低。
OBJECTIVE:To evaluate the efficacy and safety of statins on normolipidemic patients with isolated systolic hypertension(ISH).METHODS:We searched Pubmed,EMbase,Controlled Trials of Cochrane Library,CBM,CNKI and Wanfang database from the date of establishment to May 2012.We also researched relevant journals and conference proceedings by hand.RCTs about statins for normolipidemic patients with isolated systolic hypertension were collected.After quality evaluation and data extraction,Meta-analysis of included literatures was conducted using Rev Man 5.0 software.RESULTS:A total of 17 RCTs were included,involving 1 297 patients.Meta-analysis showed that statins group was more effective than control group in lowering SBP levels [MD=-4.56,95%CI(-5.60,-3.53),P<0.000 01],PP levels[MD=-8.41,95%CI(-10.44,-6.38),P<0.000 01];while statins group was more effective than control group in preventing the decrease of DBP levels[MD=3.26,95%CI(1.42,5.09),P= 0.000 5];there was no significant difference between the 2 groups in TC levels,TG levels,LDL-C levels,HDL-C levels and the incidence of adverse drug reactions.CONCLUSION:For normolipidemic patients with ISH,statins are effective in lowering SBP levels,PP levels with less adverse drug reactions.
OBJECTIVE:To evaluate the efficacy and safety of statins on normolipidemic patients with isolated systolic hypertension(ISH).METHODS:We searched Pubmed,EMbase,Controlled Trials of Cochrane Library,CBM,CNKI and Wanfang database from the date of establishment to May 2012.We also researched relevant journals and conference proceedings by hand.RCTs about statins for normolipidemic patients with isolated systolic hypertension were collected.After quality evaluation and data extraction,Meta-analysis of included literatures was conducted using Rev Man 5.0 software.RESULTS:A total of 17 RCTs were included,involving 1 297 patients.Meta-analysis showed that statins group was more effective than control group in lowering SBP levels [MD=-4.56,95%CI(-5.60,-3.53),P<0.000 01],PP levels[MD=-8.41,95%CI(-10.44,-6.38),P<0.000 01];while statins group was more effective than control group in preventing the decrease of DBP levels[MD=3.26,95%CI(1.42,5.09),P= 0.000 5];there was no significant difference between the 2 groups in TC levels,TG levels,LDL-C levels,HDL-C levels and the incidence of adverse drug reactions.CONCLUSION:For normolipidemic patients with ISH,statins are effective in lowering SBP levels,PP levels with less adverse drug reactions.
引文
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[18]刘晓辉.辛伐他汀(理舒达)对老年收缩期高血压患者脉压的影响[J].实用心脑肺血管病杂志,2008,16(1):46.
[19]王淑兰.辛伐他汀联合氨氯地平对单纯收缩期高血压患者脉压的影响[J].现代中西医结合杂志,2010,19(23):2906.
[20]刘洪.氯沙坦联合舒降之对老年人单纯收缩期高血压的影响[J].右江民族医学院学报,2003,22(5):654.
[21]万元春,安平.阿托伐他汀改善收缩期高血压患者脉压与动脉弹性的临床分析[J].中国临床实用医学,2009,3(10):59.
[22]高寒梅.观察洛伐他汀对老年单纯收缩期高血压患者脉压及动脉弹性的影响[J].中国临床实用医学,2009,3(7):24.
[23]何忠芳,刘芳,翟所迪,等.他汀类药物对脑梗死患者C-反应蛋白和颈动脉内中膜厚度影响的系统评价[J].中国循证医学杂志,2009,9(8):873.
[24]黄建凤,顾东风,宿少勇.我国成年人单纯性收缩期高血压患病率调查[J].中华预防医学杂志,2005,39(1):7.
[25]陈灵,许官学.非洛地平联合氟伐他汀钠治疗老年单纯收缩期高血压的临床观察[J].中国药房,2011,22(36):3417.
[26]Staessen JA,Gasowski J,Wang JG,et al.Risks of un-treated and treated isolated systolic hypertension in the el-derly:meta-analysis of outcome trials[J].Lancet,2000,355:865.
[27]Bonetti PO,Lerman LO,Napoli C,et al.Statin effectsbeyond lipid lowing:are they clinically relevant[J].Eur Heart J,2003,24(3):225.
[28]邹川南,李建美,张新金.辛伐他汀对老年单纯收缩期高血压压差的影响[J].中国药房,2011,22(4):356.
[2]刘同宝.单纯收缩期高血压[J].山东医药,2008,48(29):113.
[3]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701.
[4]Ferrier KE,MuhlmannMH,Baguet JP,et al.Intensive cholesterol reduction lowers blood pressure and large ar-tery stiffness in isolated systolic hypertension[J].J Am Coll Cardiol,2002,39(6):1020.
[5]Higgins JPT,Green S.Cochrane handbook for systematic reviews of interventions version5.1.0[EB/OL].[2012-01-07].http://www.Cochrane-handbook.org.
[6]漆洁.阿托伐他汀联用厄贝沙坦对老年单纯收缩期高血压患者血压的影响[J].右江民族医学院学报,2009,28(6):972.
[7]陆凤鸣,杨应军,于秋雁.阿托伐他汀和非洛地平缓释片联用对老年单纯收缩期高血压患者脉压的影响[J].中国慢性病预防与控制,2010,18(3):298.
[8]秦宁,徐俊伟,苏楠,等.阿托伐他汀治疗血脂正常老年高血压临床观察[J].心脑血管病防治,2009,9(3):205.
[9]范珂.氟伐他汀改善老年收缩期高血压患者脉压的临床观察[J].中国医师杂志,2006,18(1):132.
[10]崔淑娴,王立奎,王浩,等.阿托伐他汀改善老年收缩期高血压患者脉压与动脉弹性的研究[J].中国老年学杂志,2007,27(5),480.
[11]陈群,赵艳芳,刘平,等.阿托伐他汀钙对老年单纯收缩期高血压患者脉压的影响[J].医学综述,2011,17(24):3806.
[12]杨应军,刘幼根,朱建峰,等.阿托伐他汀并厄贝沙坦对单纯收缩期高血压患者脉压的影响[J].心血管康复医学杂志,2008,17(5):494.
[13]向红菊,潘港,王福军,等.阿托伐他汀对血脂正常的老年收缩期高血压患者脉压的影响[J].心血管康复医学杂志,2007,16(2):160.
[14]夏晓芬,彭乐明.阿托伐他汀和氨氯地平联用对老年单纯收缩期高血压患者脉压影响[J].心脑血管病防治,2008,8(4):270.
[15]徐德鸿,李勇,张荣林.阿托伐他汀和氯沙坦联合用药对老年单纯收缩期高血压患者脉压的影响[J].中国临床药学杂志,2007,16(3):142.
[16]严山.阿托伐汀联用依那普利对老年单纯收缩期高血压的作用[J].岭南心血管病杂志,2008,14(4):252.
[17]徐春霞.氯沙坦联合阿托伐他汀治疗老年人单纯性收缩压高血压疗效观察[J].中国基层医药,2011,18(14):1962.
[18]刘晓辉.辛伐他汀(理舒达)对老年收缩期高血压患者脉压的影响[J].实用心脑肺血管病杂志,2008,16(1):46.
[19]王淑兰.辛伐他汀联合氨氯地平对单纯收缩期高血压患者脉压的影响[J].现代中西医结合杂志,2010,19(23):2906.
[20]刘洪.氯沙坦联合舒降之对老年人单纯收缩期高血压的影响[J].右江民族医学院学报,2003,22(5):654.
[21]万元春,安平.阿托伐他汀改善收缩期高血压患者脉压与动脉弹性的临床分析[J].中国临床实用医学,2009,3(10):59.
[22]高寒梅.观察洛伐他汀对老年单纯收缩期高血压患者脉压及动脉弹性的影响[J].中国临床实用医学,2009,3(7):24.
[23]何忠芳,刘芳,翟所迪,等.他汀类药物对脑梗死患者C-反应蛋白和颈动脉内中膜厚度影响的系统评价[J].中国循证医学杂志,2009,9(8):873.
[24]黄建凤,顾东风,宿少勇.我国成年人单纯性收缩期高血压患病率调查[J].中华预防医学杂志,2005,39(1):7.
[25]陈灵,许官学.非洛地平联合氟伐他汀钠治疗老年单纯收缩期高血压的临床观察[J].中国药房,2011,22(36):3417.
[26]Staessen JA,Gasowski J,Wang JG,et al.Risks of un-treated and treated isolated systolic hypertension in the el-derly:meta-analysis of outcome trials[J].Lancet,2000,355:865.
[27]Bonetti PO,Lerman LO,Napoli C,et al.Statin effectsbeyond lipid lowing:are they clinically relevant[J].Eur Heart J,2003,24(3):225.
[28]邹川南,李建美,张新金.辛伐他汀对老年单纯收缩期高血压压差的影响[J].中国药房,2011,22(4):356.