氨氯地平单用及其与ACEI联用治疗成人原发性高血压有效性与安全性的Meta分析_《中国循证医学杂志》

作者：

 吕砚 ¹ , 邹最 ² , 贾怀信 ³ , 钟京 ¹ , 方伟武 ¹

1. 解放军306医院麻醉科（北京 100101）；2. 上海市长征医院麻醉科（上海 200003）；3. 北京673医院麻醉科（北京 100000）;

关键词：

氨氯地平血管紧张素转换酶抑制剂抗高血压药 Meta 分析

DOI：

10.7507/1672-2531.20100452

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　评价氨氯地平单用及其与ACEI 联用治疗成人原发性高血压的有效性与安全性。
方法　电子检索Cochrane 对照试验注册数据库（2009 年第2 期）、PubMed、EMbase、CBM、CNKI（从建库至2009 年8 月）。由两名评价者按纳入与排除标准和Cochrane 协作网推荐的简单评价法选择文献、评价质量，而后对同质研究采用Stata10.0 软件进行Meta 分析。
结果　共纳入17 个RCT，包括3 291 例病人。Meta 分析结果显示：与单用氨氯地平相比，氨氯地平与ACEI 联用能进一步降低收缩压［WMD=5.72，95%CI（4.10，7.33），P=0.016］和舒张压［WMD=3.62，95%CI（4.85，2.39），P=0.000］，总不良反应率下降［RR 0.86，95%CI（0.75，0.99），P=0.034］，其差异有统计学意义。
结论　现有证据表明，氨氯地平与ACEI 联用能进一步降低成人原发性高血压患者血压和不良反应发生率，其有效性和安全性均优于氨氯地平单用。而氨氯地平与ACEI 联用能否降低远期联合心血管事件风险，且组织型ACEI 是否更有优势，则尚需大样本、高质量的随机对照试验来进一步研究。

引用本文： 吕砚,邹最,贾怀信,钟京,方伟武. 氨氯地平单用及其与ACEI联用治疗成人原发性高血压有效性与安全性的Meta分析. 中国循证医学杂志, 2010, 10(5): 578-584. doi: 10.7507/1672-2531.20100452 复制

1.	陈少萍, 秦永文, 郑兴. 联合用药——高血压病人血压控制达标的基本策略. 药学服务与研究, 2006, 6(6): 401-405.
2.	Wu Y, Huxley R, Li L, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002. Circulation, 2008, 118(25): 2679-2686.
3.	Kostis JB, Lacy CR, Cosgrove NM, et al. Association of calcium channel blocker use with increased rate of acute myocardial infarction in patients with left ventricular dysfunction. Am Heart J, 1997, 133(5): 550-557.
4.	Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 2003, 289(19): 2560-2572.
5.	Chalmers J, MacMahon S, Mancia G, et al. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee. J Hypertens, 1999, 17(2): 151-183.
6.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7.	DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
8.	Follmann D, Elliott P, Suh I, et al. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol, 1992, 45(7): 769-773.
9.	Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
10.	Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
11.	Neutel JM, Smith DH, Weber MA. Effect of antihypertensive monotherapy and combination therapy on arterial distensibility and left ventricular mass. Am J Hypertens, 2004, 17(1): 37-42.
12.	Brown MJ, Dickerson JE. Alpha-blockade and calcium antagonism: an effective and well-tolerated combination for the treatment of resistant hypertension. J Hypertens, 1995, 13(6): 701-707.
13.	Cappuccio FP, Markandu ND, Singer DR, et al. Amlodipine and lisinopril in combination for the treatment of essential hypertension: efficacy and predictors of response. J Hypertens, 1993, 11(8): 839-847.
14.	Fogari R, Malamani GD, Zoppi A, et al. Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients. J Hum Hypertens, 2003, 17(3): 207-212.
15.	Fogari R, Preti P, Zoppi A, et al. Effects of amlodipine fosinopril combination on microalbuminuria in hypertensive type 2 diabetic patients. Am J Hypertens, 2002, 15(12): 1042-1049.
16.	Fogari R, Preti P, Lazzari P, et al. Effect of benazepril amlodipine combination on fibrinolysis in hypertensive diabetic patients. Eur J Clin Pharmacol, 2003, 59(4): 271-275.
17.	Jamerson KA, Nwose O, Jean-Louis L, et al. Initial angiotensinconverting enzyme inhibitor/calcium channel blocker combination therapy achieves superior blood pressure control compared with calcium channel blocker monotherapy in patients with stage 2 hypertension. Am J Hypertens, 2004, 17(6): 495-501.
18.	Kuschnir E, Acuna E, Sevilla D, et al. Treatment of patients with essential hypertension: amlodipine 5 mg/benazepril 20 mg compared with amlodipine 5 mg, benazepril 20 mg, and placebo. Clin Ther, 1996, 18(6): 1213-1224.
19.	MacGregor MS, Deighan CJ, Rodger RS, et al. A prospective openlabel randomised trial of quinapril and/or amlodipine in progressive non-diabetic renal failure. Nephron, 2005, 101(3): c139-149.
20.	Messerli FH, Oparil S, Feng Z. Comparison of efficacy and side effects of combination therapy of angiotensin-converting enzyme inhibitor (benazepril) with calcium antagonist (either nifedipine or amlodipine) versus high-dose calcium antagonist monotherapy for systemic hypertension. Am J Cardiol, 2000, 86(11): 1182-1187.
21.	Miranda RD, Mion D, Rocha JC, et al. An 18-week, prospective, randomized, double-blind, multicenter study of amlodipine/ramipril combination versus amlodipine monotherapy in the treatment of hypertension: the assessment of combination therapy of amlodipine/ ramipril (ATAR) study. Clin Ther, 2008, 30(9): 1618-1628.
22.	Naidu MU, Usha PR, Rao TR, et al. Evaluation of amlodipine, lisinopril, and a combination in the treatment of essential hypertension. Postgrad Med J, 2000, 76(896): 350-353.
23.	Neutel JM, Smith DH, Weber MA, et al. Efficacy of combination therapy with amlodipine besylate/benazepril hydrochloride for lowering systolic blood pressure in stage 2 hypertension. Am J Geriatr Cardiol, 2006, 15(3): 142-150.
24.	Pool J, Kaihlanen P, Lewis G, et al. Once-daily treatment of patients with hypertension: a placebo-controlled study of amlodipine and benazepril vs amlodipine or benazepril alone. J Hum Hypertens, 2001, 15(7): 495-498.
25.	Chrysant SG, Sugimoto DH, Lefkowitz M, et al. The effects of high-dose amlodipine/benazepril combination therapies on blood pressure reduction in patients not adequately controlled with amlodipine monotherapy. Blood Pressure, 2007, 1: 10-17.
26.	Mohler ER, Herrington D, Ouyang P, et al. A randomized, doubleblind trial comparing the effects of amlodipine besylate/benazepril HCl vs amlodipine on endothelial function and blood pressure. J Clin Hypertens (Greenwich), 2006, 8(10): 692-698.
27.	Ueng KC, Lin LC, Voon WC, et al. An eight-week, multicenter, randomized, double-blind study to evaluate the efficacy and tolerability of fixed-dose amlodipine/benazepril combination in comparison with amlodipine as first-line therapy in chinese patients with mild to moderate hypertension. Blood pressure, 2008, 1: 24-31.

1. 陈少萍, 秦永文, 郑兴. 联合用药——高血压病人血压控制达标的基本策略. 药学服务与研究, 2006, 6(6): 401-405.
2. Wu Y, Huxley R, Li L, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002. Circulation, 2008, 118(25): 2679-2686.
3. Kostis JB, Lacy CR, Cosgrove NM, et al. Association of calcium channel blocker use with increased rate of acute myocardial infarction in patients with left ventricular dysfunction. Am Heart J, 1997, 133(5): 550-557.
4. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA, 2003, 289(19): 2560-2572.
5. Chalmers J, MacMahon S, Mancia G, et al. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee. J Hypertens, 1999, 17(2): 151-183.
6. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials, 1986, 7(3): 177-188.
8. Follmann D, Elliott P, Suh I, et al. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol, 1992, 45(7): 769-773.
9. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101.
10. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
11. Neutel JM, Smith DH, Weber MA. Effect of antihypertensive monotherapy and combination therapy on arterial distensibility and left ventricular mass. Am J Hypertens, 2004, 17(1): 37-42.
12. Brown MJ, Dickerson JE. Alpha-blockade and calcium antagonism: an effective and well-tolerated combination for the treatment of resistant hypertension. J Hypertens, 1995, 13(6): 701-707.
13. Cappuccio FP, Markandu ND, Singer DR, et al. Amlodipine and lisinopril in combination for the treatment of essential hypertension: efficacy and predictors of response. J Hypertens, 1993, 11(8): 839-847.
14. Fogari R, Malamani GD, Zoppi A, et al. Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients. J Hum Hypertens, 2003, 17(3): 207-212.
15. Fogari R, Preti P, Zoppi A, et al. Effects of amlodipine fosinopril combination on microalbuminuria in hypertensive type 2 diabetic patients. Am J Hypertens, 2002, 15(12): 1042-1049.
16. Fogari R, Preti P, Lazzari P, et al. Effect of benazepril amlodipine combination on fibrinolysis in hypertensive diabetic patients. Eur J Clin Pharmacol, 2003, 59(4): 271-275.
17. Jamerson KA, Nwose O, Jean-Louis L, et al. Initial angiotensinconverting enzyme inhibitor/calcium channel blocker combination therapy achieves superior blood pressure control compared with calcium channel blocker monotherapy in patients with stage 2 hypertension. Am J Hypertens, 2004, 17(6): 495-501.
18. Kuschnir E, Acuna E, Sevilla D, et al. Treatment of patients with essential hypertension: amlodipine 5 mg/benazepril 20 mg compared with amlodipine 5 mg, benazepril 20 mg, and placebo. Clin Ther, 1996, 18(6): 1213-1224.
19. MacGregor MS, Deighan CJ, Rodger RS, et al. A prospective openlabel randomised trial of quinapril and/or amlodipine in progressive non-diabetic renal failure. Nephron, 2005, 101(3): c139-149.
20. Messerli FH, Oparil S, Feng Z. Comparison of efficacy and side effects of combination therapy of angiotensin-converting enzyme inhibitor (benazepril) with calcium antagonist (either nifedipine or amlodipine) versus high-dose calcium antagonist monotherapy for systemic hypertension. Am J Cardiol, 2000, 86(11): 1182-1187.
21. Miranda RD, Mion D, Rocha JC, et al. An 18-week, prospective, randomized, double-blind, multicenter study of amlodipine/ramipril combination versus amlodipine monotherapy in the treatment of hypertension: the assessment of combination therapy of amlodipine/ ramipril (ATAR) study. Clin Ther, 2008, 30(9): 1618-1628.
22. Naidu MU, Usha PR, Rao TR, et al. Evaluation of amlodipine, lisinopril, and a combination in the treatment of essential hypertension. Postgrad Med J, 2000, 76(896): 350-353.
23. Neutel JM, Smith DH, Weber MA, et al. Efficacy of combination therapy with amlodipine besylate/benazepril hydrochloride for lowering systolic blood pressure in stage 2 hypertension. Am J Geriatr Cardiol, 2006, 15(3): 142-150.
24. Pool J, Kaihlanen P, Lewis G, et al. Once-daily treatment of patients with hypertension: a placebo-controlled study of amlodipine and benazepril vs amlodipine or benazepril alone. J Hum Hypertens, 2001, 15(7): 495-498.
25. Chrysant SG, Sugimoto DH, Lefkowitz M, et al. The effects of high-dose amlodipine/benazepril combination therapies on blood pressure reduction in patients not adequately controlled with amlodipine monotherapy. Blood Pressure, 2007, 1: 10-17.
26. Mohler ER, Herrington D, Ouyang P, et al. A randomized, doubleblind trial comparing the effects of amlodipine besylate/benazepril HCl vs amlodipine on endothelial function and blood pressure. J Clin Hypertens (Greenwich), 2006, 8(10): 692-698.
27. Ueng KC, Lin LC, Voon WC, et al. An eight-week, multicenter, randomized, double-blind study to evaluate the efficacy and tolerability of fixed-dose amlodipine/benazepril combination in comparison with amlodipine as first-line therapy in chinese patients with mild to moderate hypertension. Blood pressure, 2008, 1: 24-31.

《中国循证医学杂志》

氨氯地平单用及其与ACEI联用治疗成人原发性高血压有效性与安全性的Meta分析

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《中国循证医学杂志》

氨氯地平单用及其与ACEI联用治疗成人原发性高血压有效性与安全性的Meta分析

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