作者：吴章宝1 ，刘延敏2 ，李军3

单位：

1.067000河北省承德市，承德医学院　2.261000山东省潍坊市，潍坊医学院附属医院护理部　3.067000河北 省承德市，承德医学院附属医院全科医疗科

Units：

1.Chengde Medical University, Chengde 067000, China 2.Nursing Department, Affiliated Hospital of Weifang Medical University, Weifang 261000, China 3.Department of Family Medicine, Affiliated Hospital of Chengde Medical University, Chengde 067000, China

关键词：

高血压；老年人；降压药；认知；网状Meta分析

Keywords：

Hypertension; Aged; Antihypertensive agents; Cognition; Network Meta-analysis

CLC：

R 544.1

DOI：

10.12114/j.issn.1008-5971.2023.00.319

Funds：

河北省2020年度医学科学研究课题计划项目（20200376）

摘要：

　目的　采用网状Meta分析方法评估不同降压方案对中老年高血压患者认知功能及血压变化的影响。 方法　计算机检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方数据知识服务平台、维普网 公开发表的不同降压方案治疗中老年高血压患者的随机对照试验（RCT），检索时限从建库至2023年1月。提取纳入 文献的资料，使用Cochrane偏倚风险评价工具对纳入文献进行质量评价。采用Review Manager 5.3、Stata 16.0软件进行 数据分析和图形绘制。采用累积排序概率曲线下面积（SUCRA）比较不同降压方案对中老年高血压患者认知功能评 分变化幅度及血压变化幅度的影响。结果　共纳入13篇文献，包含9 564例中老年高血压患者，涉及6种降压方案。网 状Meta分析结果显示，接受血管紧张素Ⅱ受体拮抗剂（ARB）治疗的中老年高血压患者认知功能评分变化幅度大于接 受常规干预〔标准均数差（SMD）=0.46，95%CI（0.23～0.70）〕、血管紧张素转换酶抑制剂（ACEI）〔SMD=0.33， 95%CI（0.06～0.61）〕、β-受体阻滞剂（BB）〔SMD=0.48，95%CI（0.17～0.78）〕、利尿剂治疗的中老年高血 压患者〔SMD=0.32，95%CI（0.01～0.63）〕；接受钙通道阻滞剂（CCB）治疗的中老年高血压患者认知功能评分变 化幅度大于接受常规干预〔SMD=0.37，95%CI（0.04～0.70）〕、BB治疗的中老年高血压患者〔SMD=0.38，95%CI （0.02～0.74）〕。接受不同降压方案治疗的中老年高血压患者认知功能评分变化幅度的SUCRA从大到小依次为ARB （93.6%）、CCB（81.2%）、利尿剂（47.1%）、ACEI（43.4%）、常规干预（17.9%）、BB（16.8%）。接受ARB、 BB、利尿剂治疗的中老年高血压患者SBP变化幅度大于接受常规干预治疗的中老年高血压患者〔SMD=0.99，95%CI （0.53～1.45）；SMD=0.66，95%CI（0.09～1.24）；SMD=0.60，95%CI（0.10～1.09）〕。接受不同降压方案治疗 的中老年高血压患者SBP变化幅度的SUCRA从大到小依次为ARB（81.9%）、CCB（71.7%）、BB（51.7%）、利尿 剂（45.6%）、ACEI（45.3%）、常规干预（3.9%）。接受ARB治疗的中老年高血压患者DBP变化幅度大于接受常规 干预治疗的中老年高血压患者〔SMD=0.92，95%CI（0.01～1.82）〕。接受不同降压方案治疗的中老年高血压患者 DBP变化幅度的SUCRA从大到小依次为ARB（82.5%）、BB（65.5%）、利尿剂（44.3%）、ACEI（41.8%）、CCB （37.0%）、常规干预（28.9%）。结论　现有证据表明，与常规干预、ACEI、BB、CCB、利尿剂相比，ARB在改善 中老年高血压患者认知功能及降低SBP、DBP方面可能是最优方案。

Abstract：

　Objective To evaluate the effect of different antihypertensive regimens on cognitive function and blood pressure changes in middle-aged and elderly patients with hypertension using network meta-analysis. Methods Databases including PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, VIP were retrieved to search for randomized controlled trials (RCT) of different antihypertensive regimens in the treatment of middle-aged and elderly patients with hypertension. The search deadline was from the establishment of the database to January 2023. The data of the included literature was extracted, the Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the included literature. Review Manager 5.3 and Stata 16.0 software were used for data analysis and graphic rendering. The surface under the cumulative ranking curve (SUCRA) was used to compare the effect of different antihypertensive regimens on cognitive function and blood pressure changes range in middle-aged and elderly patients with hypertension. Results A total of 13 literature were included in this study, including 9 564 middle-aged and elderly patients with hypertension and 6 kinds of antihypertensive regimens. The results of network meta-analysis showed that: the cognitive function score change range in middle-aged and elderly patients with hypertension treated with angiotensin Ⅱ receptor blocker (ARB) was lager than that in middle-aged and elderly patients with hypertension treated with conventional intervention [standard mean difference (SMD) =0.46, 95%CI (0.23-0.70) ] , angiotensin converting enzyme inhibitor (ACEI) [SMD=0.33, 95%CI (0.06-0.61) ] , beta-receptor blocker (BB) [SMD=0.48, 95%CI (0.17- 0.78) ] , diuretic [SMD=0.32, 95%CI (0.01-0.63) ] ; the cognitive function score change range in middle-aged and elderly patients with hypertension treated with calcium channel blocker (CCB) was higher than that in middle-aged and elderly patients treated with conventional intervention [SMD=0.37, 95%CI (0.04-0.70) ] , BB [SMD=0.38, 95%CI (0.02-0.74) ] . SUCRA of cognitive function score change range in middle-aged and elderly patients with hypertension treated with different antihypertensive regimens was ARB (93.6%) , CCB (81.2%) , diuretic (47.1%) , ACEI (43.4%) , conventional intervention (17.9%) , BB (16.8%) in descending order. The SBP change range in middle-aged and elderly patients with hypertension treated with ARB, BB, diuretic was higher than that in middle-aged and elderly patients with hypertension treated with conventional intervention [SMD=0.99, 95%CI (0.53-1.45) ; SMD=0.66, 95%CI (0.09-1.24) ; SMD=0.60, 95%CI (0.10-1.09) ] . SUCRA of SBP change range in middle aged and elderly patients with hypertension treated with different antihypertensive regimens was ARB (81.9%) , CCB (71.7%) , BB (51.7%) , diuretic (45.6%) , ACEI (45.3%) , conventional intervention (3.9%) in descending order. The DBP change range in middle-aged and elderly patients with hypertension treated with ARB was higher than that in middle-aged and elderly patients with hypertension treated with conventional intervention [SMD=0.92, 95%CI (0.01-1.82) ] . SUCRA of DBP change range in middle-aged and elderly patients with hypertension treated with different antihypertensive regimens was ARB (82.5 %) , BB (65.5%) , diuretic (44.3%) , ACEI (41.8%) , CCB (37.0%) , conventional intervention (28.9%) in descending order. Conclusion The available evidence shows that compared with conventional intervention, ACEI, BB, CCB and diuretic, ARB may be the best regimen for improving cognitive function and reducing SBP and DBP in middle-aged and elderly patients with hypertension.

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