摘要
目的系统评价不同剂量美托洛尔治疗原发性高血压的疗效与安全性。方法检索所有有关不同剂量美托洛尔治疗原发性高血压的随机对照试验(RCT)与自身前后对照试验,根据纳入和排除标准筛选文献、提取资料和进行质量评价,并用RevMan4.2.8软件对数据进行Meta分析。结果共纳入5个试验,其中2篇为较高质量研究,3篇为低质量研究。5篇文献均未报告各治疗组高血压患者的病死率和心血管事件(脑卒中、急性冠脉综合征、肾功能不全)发生率,有4篇文献报告了各组治疗前后收缩压和舒张压水平以及心率的均值和标准差。对其中两篇不同剂量自身前后对照试验治疗后的收缩压及舒张压水平进行Meta分析,结果显示,收缩压水平OR=–4.6[95%CI(–7.77,–1.47),P=0.004];舒张压水平OR=–5.71[95%CI(–6.75,–4.68),P<0.00001]。4篇文献报告了不良反应,对不同剂量治疗后非特异性不良反应发生率进行Meta分析,结果显示OR=2.61[95%CI(1.33,5.13),P=0.005]。结论美托洛尔治疗高血压存在一定的量效关系,小剂量美托洛尔降压效果不理想时,增加剂量可明显降低血压。虽然大剂量组的不良反应发生率较高,但大多数病人可以耐受。因此在使用美托洛尔治疗高血压时,可根据患者耐受性个体化用药,逐步增加剂量到最大耐受剂量,使血压控制在理想水平。
Objective To evaluate the efficacy and safety of different doses of metoprolol in the treatment of primary hypertension. Methods We searched for randomized controlled trials of different doses of metoprolol in the treatment of primary hypertension. We screened relevant studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by using The Cochrane Collaboration＇s Revman 4.2.8 software. Results Five randomized controlled trials of different doses of metoprolol in the treatment of primary hypertension were included. Two were of high quality and the other three were of low quality. No study reported mortality or the incidence of cardiovascular events, but four studies reported the means and standard deviations of systolic and diastolic blood pressures and heart rate. Based on the two self-control studies, meta-analyses of the levels of systolic and diastolic blood pressures before and after treatment of different doses of metoprolol showed that the combined OR for systolic blood pressure levels was -4.62 [95%CI （-7.77, -1.47）, P=0.004]; and for the diastolic blood pressure levels, the combined OR was -5.71 [95%CI （-6.75, -4.68）, P〈0.000 01 ]. Four studies reported adverse reactions, and meta-analysis of the incidence of non- specific adverse reactions showed that the combined OR was 2.61 [95%CI （1.33, 5.13）, P=0.005]. Conclusion Adoseeffect relationship may exist between the dose of metoprolol and antilhypertensive effect in the treatment of hypertension. When the antihypertensive effect of low-dose metoprolol was inadequate, an increase in the dose may lower blood pressure further. Although high-dose metoprolol has higher incidence of adverse reactions, it can be tolerated by most patients. Therefore, in the treatment of hypertension with metoprolol, an individualized dosing regimen can be applied according to the patient＇s tolerance, and blood pressure may be controlled ideally by a gradual increase of the metoprolol dose to its maximum tolerated dose.
出处
《中国循证医学杂志》
CSCD
2007年第11期802-809,共8页
Chinese Journal of Evidence-based Medicine
