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目的系统评价血管紧张素转化酶抑制剂(ACEI)联合血管紧张素Ⅱ受体阻滞剂(ARB)对高血压左室肥厚逆转作用的有效性和安全性。方法计算机检索Cochrane图书馆、PubMed、Embase、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、中国期刊全文数据库(CNKI),对纳入的随对照试验(RCT)进行质量评价,并用RevMan 5.1软件进行Meta分析。结果共纳入12项研究,进行Meta分析的患者合计835例。结果显示,左心室质量指数(LVMI)改善联合组优于单用ARB组,差异有统计学意义[MD=-14.74,95%CI(-16.71,-12.76),P<0.000 01];平均24 h动态血压(收缩压)组间差异有统计学意义,但无临床意义[MD=-2.33,95%CI(-4.54,-0.12),P=0.04];总不良反应和干咳发生率组间差异均无统计学意义[RR=1.24,95%CI(0.58,2.63),P=0.57]和[RR=7.13,95%CI(0.92,55.54),P=0.06]。结论 ACEI联合ARB对高血压左室肥厚的逆转作用优于单用ARB,且不增加不良反应。但纳入研究整体质量不高,仍须高质量RCT进一步证实。
Objective To evaluate the efficacy and safety of the combination of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin Ⅱ receptor blocker (ARB) on the reversal of left ventricular hypertrophy in hypertensive patients. Methods The Cochrane Library, PubMed, Embase, Chinese Biomedical Literature Database (CBM), VIP Chinese Science Database (CNKI) and Chinese Journal Full-text Database (CNKI) were searched by computer. The quality of included RCTs was evaluated, Meta-analysis was performed using RevMan 5.1 software. Results A total of 12 studies were included and a total of 835 patients underwent meta-analysis. The results showed that the improvement of left ventricular mass index (LVMI) in combination group was superior to that of ARB alone group, with significant difference (MD = -14.74, 95% CI, -16.71, -12.76, P <0.000 01) h ambulatory blood pressure (systolic blood pressure) between the two groups was statistically significant, but no clinical significance [MD = -2.33,95% CI (-4.54, -0.12), P = 0.04]; total adverse reactions and the incidence of dry cough The differences were not statistically significant (RR = 1.24, 95% CI (0.58, 2.63), P = 0.57] and [RR = 7.13, 95% CI (0.92, 55.54), P = 0.06]. Conclusion The reversal effect of ACEI combined with ARB on hypertensive left ventricular hypertrophy is superior to that of ARB alone and no adverse reactions are observed. However, the quality of the studies included in the study is not high, which still needs further confirmation by high-quality RCTs.