摘要目的 系统评价临床药物治疗盐敏感性高血压的效果.方法 计算机检索PubMed、Embase、Cochrane Library、中国生物医学文献数据库、万方数据知识服务平台、维普中文期刊服务平台和中国知网数据库,搜集关于临床药物治疗盐敏感性高血压的随机对照试验(RCT),检索时限均从建库至2018年12月.由两位研究者独立筛选文献、提取资料,一位研究者评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行荟萃分析.结果 共纳入16个RCT研究,1 355例患者.荟萃分析结果显示,血管紧张素转化酶抑制剂(ACEI)联合利尿剂能有效降低盐敏感性高血压患者24h动态收缩压变异性[均数差(MD)--=4.45,95％CI:3.47～5.43,P＜0.001]和24h动态舒张压变异性(MD=3.71,95％CI:2.83～4.59,P＜0.001);血管紧张素Ⅱ受体拮抗剂(ARB)联合利尿剂对盐敏感性高血压患者24h动态血压变异性无明显影响.单独使用利尿剂吲达帕胺可以降低盐敏感性高血压患者的收缩压(MD=-14.70,95％CI:-18.57～-10.83,P＜0.001)和舒张压(MD=-8.73,95％CI:-11.57～-5.89,P＜0.001);单独使用ACEI不能降低盐敏感性高血压患者收缩压(MD=2.20,95％CI:-1.48～5.88,P=0.240)和舒张压(MD=2.95,95％CI:1.37～4.54,P＜0.001);氨氯地平联合二甲双胍对盐敏感性高血压患者有降压作用(RR=1.23,95％CI:1.14～1.33,P＜0.001).结论 ACEI联合利尿剂能有效降低盐敏感性高血压患者血压的变异性,氨氯地平联合二甲双胍以及单独使用吲达帕胺对盐敏感性高血压患者有降压作用.

abstractsObjective To assess the effects of clinical medicine on salt sensitive hypertension.Methods The PubMed,EMBASE,Cochrane Library,CBM,WanFang Data,VIP and CNKI databases were searched to collect randomized controlled trials (RCTs) on clinical medicine in treating salt sensitive hypertension from inception to December 2018.Two reviewers independently screened the literature,extracted data,and another investigator assessed the risk of bias included in the study.Then meta-analysis was performed using RevMan 5.3 software.Results A total of 16 RCTs studies involving 1 355 patients were included.Meta-analysis showed that angiotensin-converting enzyme inhibitors (ACEIs) combined with diuretics could effectively reduce 24 h systolic blood pressure variability [mean difference (MD)=4.45,95％CI:3.47-5.43,P＜0.001] and 24 h diastolic blood pressure variability (MD=3.71,95％CI:2.83-4.59,P＜ 0.001) in salt-sensitive hypertension patients.Angiotensin Ⅱ receptor antagonists (ARBs) combined with diuretics had no antihypertensive effect on salt-sensitive hypertension patients.Indapamide alone can reduce systolic blood pressure (MD=-14.70,95％CI:-18.57--10.83,P＜0.001) and diastolic blood pressure (MD=-8.73,95％CI:-11.57--5.89,P＜0.001).The use of ACEIs alone in salt-sensitive hypertension patients can not reduce systolic pressure (MD=2.20,95％CI:-1.48-5.88,P=0.240) and diastolic pressure (MD=2.95,95％CI:1.37～4.54,P＜0.001).Amlodipine combined with metformin had therapeutic effect on salt-sensitive hypertension (RR=1.23,95％CI:1.14～1.33,P＜0.001).Conclusions ACEIs combined with diuretics can effectively reduce blood pressure variability in salt-sensitive hypertensive patients.The use of amlodipine in combination with metformin and indapamide alone have antihypertensive effect in salt-sensitive hypertensive patients.