氯沙坦与阿替洛尔对心脑血管事件影响的循证分析

被引：6

作者：

杨莉萍

刘瑶

谢婧

胡欣

机构：

[1] 卫生部北京医院药学部

来源：

中国循证医学杂志 | 2013年 / 02期

关键词：

氯沙坦; 阿替洛尔; 高血压; 心脑血管事件; 随机对照试验;

D O I：

暂无

中图分类号：

R544.1 [高血压];

学科分类号：

100201 [内科学];

摘要：

目的为《中国基本药物目录》遴选血管紧张素Ⅱ受体阻断剂(ARB)类降压药物提供循证研究数据。方法以losartan、atenolol、clinical trial、氯沙坦、阿替洛尔、临床试验为检索词,计算机检索EMbase、PubMed、Cochrane图书馆、Clinicaltrials.gov、CNKI、VIP和CBM,纳入氯沙坦与阿替洛尔治疗高血压相关的临床试验,语种限中、英文。结果共纳入52篇文献,多数来源于氯沙坦减少高血压患者终点事件(LIFE)研究。其主要结果显示:①在降压效果相当的情况下,氯沙坦比阿替洛尔的耐受性更好、降低高血压患者的左室肥厚作用更好;②氯沙坦防治心脑血管事件的发生,特别是预防脑卒中首次发作的效果也更好;③氯沙坦对伴/不伴有糖尿病、伴/不伴有房颤、有低血红蛋白或高血尿酸,以及合用阿司匹林或氢氯噻嗪患者的治疗效果均优于阿替洛尔;④无论用氯沙坦还是阿替洛尔,强化降压治疗会增加有QRS间期延长的高血压患者发生心源性猝死的风险;⑤对吸烟、少量或大量饮酒的高血压患者,氯沙坦的作用均优于阿替洛尔;⑥氯沙坦和阿替洛尔在非洲裔、不同性别、血管紧张素转化酶基因突变的高血压患者中的作用无显著差别。结论氯沙坦与阿替洛尔的降压效果相当,但氯沙坦比阿替洛尔能更有效地降低高血压患者的左室肥厚,且氯沙坦带给高血压患者降压以外的益处远比阿替洛尔多,如降低尿蛋白和尿酸,不降低高密度脂蛋白等方面的作用。

引用

页码：196 / 203

页数：8

共 17 条

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