ACEI抗高血压药时辰疗法的Meta分析

摘要

目的 系统评价ACEI抗高血压药物时辰服药对比常规服药治疗高血压的疗效和安全性,为临床治疗提供循证参考.方法 计算机检索PubMed、ACP、MEDLINE、EMBASE、中国知网CNKI、万方数据库、中文科技期刊全文数据库,检索ACEI抗高血压药物时辰服药对比常规服药方式治疗高血压的系列研究,提取资料并评价质量后,采用Rev Man5.0统计软件进行Meta分析.结果 共纳入12项临床研究,合计1286例患者.Meta分析结果显示,时辰服药组的24h平均收缩压(RR=1.41,P＜0.00001,95％CI[-3.15,5.97])、24 h平均舒张压(RR=-1.76,P＜0.00001,95％CI[-2.78,3.09])、白天平均收缩压(RR=2.33,P=0.0007,95％CI[-1.45,6.1])、夜间平均收缩压(RR=-3.96,P=0.002,95％CI[-7.42,-0.5])、夜间平均舒张压(RR=-6.31,P=0.0001,95％CI[-9.31,-1.16])低于常规服药组,差异有统计学意义;而白天平均舒张压(RR=0.41,P=0.4,95％CI[-0.55,1.36])与常规服药组相比,差异无统计意义.结论 ACEI类抗高血压药物按照时间疗法管理的降压效果优于常规疗法.但是受到纳入研究方法学质量的限制,该结论有待大样本、高质量的随机对照试验进一步验证.%Objective To systematically evaluate the efficacy and safety ofACEI antihypertensive medicine chronotherapy,to provide evidence-based reference for clinical treatment.Methods Searched PubMed,ACP,MEDLINE,EMBASE,CNKI,Wanfang database,Chinese Science and Technology Journal Full-text Database,to retrieve the series study ofACEI antihypertensive medicine chronotherapy compared to conventional treatment,Rev Man5.0 statistical software was used for meta-analysis.Results A total of 12 articles with 1286 cases were included in the study.Meta analysis results showed that 24hSBP (RR=I.41,P＜0.00001,95％CI[-3.15,5.97]),24hDBP (RR=-l.76,P＜0.00001,95％CI[-2.78,3.09]),dMSBP (RR=2.33,P=0.0007,95％CI[-1.45,6.1]),nMSBP (RR=-3.96,P=0.002,95％CI[-7.42,-0.5]),nMDBP (RR=-6.31,P＝0.0001,95％CI[-9.31,-1.16])in chronotherapy group were lower than those in conventional treatment group,with statistically significant differences between two groups.There was no statistically significant difference in dMDBP between two groups (RR=0.41,P=0.4,95％CI[-0.55,1.36]).Conclusions The effect of ACEI antihepertensive drug management according to the chronotherapy was superior to conventional therapy.Limited by the quality of research methodology,the conclusion needed large sample,high quality randomized controlled trials to further verification.