中国临床药学杂志2024，Vol.33Issue(3)：176-184,9.DOI:10.19577/j.1007-4406.2024.03.003
高血压合并卒中二级预防降压药物方案选择的网状Meta分析
Comparative efficacy of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke:a network Meta-analysis
摘要
Abstract
AIM To explore the efficacy of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke.METHODS A literature search was conducted for randomized controlled trials(RCTs)regarding antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke from databases involving China National Knowledge Infrastructure(CNKI),VIP database,WanFang database,Cochrane Library,PubMed and Embase databases from their inception to 2023.The quality and risk of bias of the literature were assessed by the Cochrane Collaboration's tool(version 5.2).The evaluation indicators were stroke recurrence rate(SRR)or stroke mortality rate(SMR).The effect size was measured using odds ratios(OR)with a 95％confidence interval(95％CI)and the surface under the cumulative ranking curve(SUCRA)for evaluation.RESULTS A total of 38 RCTs included 44091 patients,involving 13 kinds of therapy such as placebo or basic treatment,angiotensin-converting enzyme inhibitor(ACEI),calcium channel blocker(CCB),diuretic(Diu),angiotensin Ⅱ receptor antagonist(ARB),β-receptor blocker(BB),CCB+Diu,Diu+central nervous system hypotension(CNS),ACEI+CCB,ACEI+folic acid(FA),ARB+Diu,ACEI+Diu,and ACEI+BB.None of the literature described the completeness of the results,selective reporting,or other biases.Network Meta-analysis 95％CI showed,as for SRR,ARB was superior to Placebo,Diu,and CCB,ACEI+Diu was superior to ACEI,Diu+CNS,and ACEI+CCB was superior to CCB,ACEI,Diu+CNS.In reducing SMR,ARB and ACEI were superior to CCB,and ARB and ACEI+CCB were superior to BB.In term of reducing SRR,the SUCRA order of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke was as follows:ACEI+CCB＞ARB＞ACEI+Diu＞CCB+Diu＞BB＞Placebo＞ACEI+FA＞ACEI+BB＞ARB+Diu＞Diu＞CCB＞ACEI＞Diu+CNS.In reducing SMR,the SUCRA order was:ARB＞ACEI+CCB＞Diu+CNS＞ACEI+BB＞Placebo＞CCB＞ACEI＞BB.CONCLUSION Based on the existing clinical evidence,ACEI+CCB and ARB are recommended for the selection of antihypertensive agents for secondary prevention of hypertension complicated with ischemic stroke.However,further multicenter,large-sample,high-quality RCTs are needed to validate these findings.关键词
高血压/卒中/二级预防/降压药物/网状Meta分析/随机对照试验Key words
hypertension/stroke/secondary prevention/antihypertensive agents/network Meta-analysis/randomized controlled trial引用本文复制引用
王群,李萍,崔玉萍,王子红,张荻,谢慧,宋海燕,孙世光..高血压合并卒中二级预防降压药物方案选择的网状Meta分析[J].中国临床药学杂志,2024,33(3):176-184,9.基金项目
山东省中医药高层次人才培育项目(编号:鲁卫函[2023]143号) （编号:鲁卫函[2023]143号）
山东省自然科学基金(编号ZR2019MH063) （编号ZR2019MH063）
张红星全国名老中医药专家传承工作室建设项目(编号:国中医药办人教函[2022]75号) （编号:国中医药办人教函[2022]75号）
刘向红全国老中医药专家学术经验继承工作项目(编号:国中医药办人教函[2022]76号) （编号:国中医药办人教函[2022]76号）
山东省重点研发计划项目(编号2019GNC21307) （编号2019GNC21307）
山东省医药卫生科技发展计划项目(编号2018WS199) （编号2018WS199）
