联合小剂量螺内酯治疗顽固性高血压疗效和安全性的Meta分析

摘要

目的:系统评价小剂量螺内酯联合三联抗高血压药物治疗顽固性高血压的疗效性和安全性.方法:检索英文数据库Pubmed、Embase、Cochrane Collaboration和中文数据库中国期刊全文数据库、万方及维普,检索目前已知的联合小剂量螺内酯治疗顽固性高血压病的临床随机对照试验,检索时间为建库至2016年10月,应用RevMan5.3软件对检索到的相关文献进行筛选、提取数据资料并作Meta分析.结果:纳入9篇文献,共计1 410例患者.Meta分析显示,联合小剂量螺内酯组与安慰剂组相比,其对收缩压的作用更明显,降低门诊/家庭收缩压[MD=-11.65,95％CI(-15.08,-8.23),P＜0.00001],降低24h收缩压[MD=-9.93,95％ CI(-12.25,-7.61),P＜0.00001];对舒张压的作用较弱,降低门诊/家庭舒张压[MD=-5.36,95％ CI(-6.67,-4.05),P＜0.00001],降低24h舒张压[MD=-4.37,95％ CI(-7.42,-1.32),P=0.005].安全性方面,联合小剂量螺内酯组与安慰剂组相比,有升高血钾作用,[MD=0.38,95％ CI(0.27,0.48),P＜0.00001];有升高血肌酐的趋势,[MD=0.79,95％ CI(-9.23,10.81)],但差异无统计学意义P=0.88.结论:联合小剂量螺内酯治疗顽固性高血压是相对有效和安全的.%Objective:To systematically review the clinical efficacy and safety of triple antihypertensive therapy combined with low-dose spironolactone in the treatment of resistant hypertension (RH).Methods:The randomized controlled trials (RCT) of RH treatments with triple antihypertensive therapy combined with lowdose of spironolactone searched in English databases Pubmed,Embase,Cochrane Collaboration and Chinese databases CNKI,Wanfang,and VIP Database. The timeframe of the databases used was from the time of database establishment up to October 2016.RevMan5.3 software was used to retrieve the related literatures,extract the data,and perform Meta-analysis.Results:A total of 1410 patients in the 9 publications were included.and analyzed in this study.The result from Meta-analysis showed that,compared to the placebo treatment,the combination of low-dose spironolactone was more effective in reducing systolic blood pressure.It,reduced clinic/home systolic blood pressure [MD =-11.65,95 ％ CI(-15.08,-8.23),P ＜ 0.00001],and 24 hours systolic blood pressure [MD =-9.93,95％ CI(-12.25,-7.61),P ＜0.00001].Its effect on reducing the diastolic blood pressure is relatively mild.It reduced clinic/home diastolic blood pressure [MD =-5.36,95％ CI (-6.67,-4.05),P ＜ 0.00001],and 24 hours diastolic blood pressure [MD =-4.37,95 ％ CI (-7.42,-1.32),P =0.005].Regarding the safety and side effects,the combined treatment with low-dose spironolactone,compared with control treatment,increased blood potassium level [MD =0.38,95％ CI(0.27,0.48),P ＜ 0.00001],had a trend to increase serum creatinine [MD =0.79,95％ CI(-9.23,10.81),P =0.88].Conclusion:Current evidence shows that the anti-hypertensive drugs combined with low-dose spironolactone is relatively safe and effective in treatment of resistant hypertension.