• 四川大學(xué)華西醫(yī)院老年科 （成都 610041）;

目的　 系統(tǒng)評(píng)價(jià)不同劑量美托洛爾治療原發(fā)性高血壓的療效與安全性。
方法　 檢索所有有關(guān)不同劑量美托洛爾治療原發(fā)性高血壓的隨機(jī)對(duì)照試驗(yàn)（RCT）與自身前后對(duì)照試驗(yàn)，根據(jù)納入和排除標(biāo)準(zhǔn)篩選文獻(xiàn)、提取資料和進(jìn)行質(zhì)量評(píng)價(jià)，并用RevMan 4.2.8軟件對(duì)數(shù)據(jù)進(jìn)行Meta分析。
結(jié)果　 共納入5個(gè)試驗(yàn)，其中2篇為較高質(zhì)量研究，3篇為低質(zhì)量研究。5篇文獻(xiàn)均未報(bào)告各治療組高血壓患者的病死率和心血管事件（腦卒中、急性冠脈綜合征、腎功能不全）發(fā)生率，有4篇文獻(xiàn)報(bào)告了各組治療前后收縮壓和舒張壓水平以及心率的均值和標(biāo)準(zhǔn)差。對(duì)其中兩篇不同劑量自身前后對(duì)照試驗(yàn)治療后的收縮壓及舒張壓水平進(jìn)行Meta分析，結(jié)果顯示，收縮壓水平OR= –4.6［95％CI（–7.77，–1.47），P=0.004］；舒張壓水平OR= –5.71［95％CI（–6.75，–4.68），P lt;0.00001］。4篇文獻(xiàn)報(bào)告了不良反應(yīng)，對(duì)不同劑量治療后非特異性不良反應(yīng)發(fā)生率進(jìn)行Meta分析，結(jié)果顯示OR=2.61［95％CI（1.33，5.13），P=0.005］。
結(jié)論　 美托洛爾治療高血壓存在一定的量效關(guān)系，小劑量美托洛爾降壓效果不理想時(shí)，增加劑量可明顯降低血壓。雖然大劑量組的不良反應(yīng)發(fā)生率較高，但大多數(shù)病人可以耐受。因此在使用美托洛爾治療高血壓時(shí)，可根據(jù)患者耐受性個(gè)體化用藥，逐步增加劑量到最大耐受劑量，使血壓控制在理想水平。

引用本文： 夏竹青,董碧蓉. 不同劑量美托洛爾治療原發(fā)性高血壓的療效與安全性評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2007, 07(11): 802-809. doi: 復(fù)制

1. Gu FS. Progress on diagnosis and treatment of hypertension. Chinese Journal of Practical Internal Medicine, 2000, 20(1): 4.
2. Wang W, Liu LS. The relationship between blood pressure level and cerebral stroke recurrence—four-year follow up of 1520 patients with cerebrovascular diseases. Chinese Journal of Hypertension, 2003, 11: 106-108.
3. Wang W, Ma LY, Liu MB. Antihypertensive therapy is the key to prevent cardiovascular disease—a retrospective analysis of 29 randomized controlled trials. Chinese Journal of Medical Guide, 2004, 6(4): 259-261.
4. MOH, MOST, NBS. Survey on nutrition and health status of Chinese residents in 2002. Beijing: People’s Medical Publishing House, 2005. 1-25.
5. Liu M, Liu GP, Qi J. Metoprolol in the treatment of primary hypertension (210 cases report). Hainan Medical Journal, 2006, 17(11): 76.
6. Jin T. Common adverse reaction caused by metoprolol— nervous system symptom. Capital Medicine, 2006, 6: 31-32.
7. Chinese committee on guide of hypertension prevention and treatment. The guidelines for prevention and treatment of hypertension in China (revised edition 2005). Chinese Journal of Hypertension, 2005, 134(Suppl): 2-41.
8. 顧復(fù)生. 高血壓病診斷治療的最新進(jìn)展.中國(guó)實(shí)用內(nèi)科雜志, 2000, 20(1): 4.
9. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet, 1990, 335: 827-839.
10. 王文, 劉力生. 血壓水平與腦卒中再發(fā)的關(guān)系—1520例腦血管病患者隨訪4年. 高血壓雜志, 2003, 11: 106-108.
11. 王文, 馬麗媛, 劉明波. 降低血壓水平是預(yù)防心腦血管事件的關(guān)鍵——29項(xiàng)隨機(jī)對(duì)照降壓臨床試驗(yàn)回顧分析. 中國(guó)醫(yī)藥導(dǎo)刊, 2004, 6(4): 259-261.
12. 衛(wèi)生部, 科技部, 國(guó)家統(tǒng)計(jì)局. 中國(guó)居民營(yíng)養(yǎng)與健康狀況調(diào)查報(bào)告2002. 北京: 人民衛(wèi)生出版社, 2005. 1-25.
13. 劉敏, 劉光平, 祁健. 美托洛爾治療原發(fā)性高血壓210例臨床觀察. 海南醫(yī)學(xué), 2006, 17(11): 76.
14. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354: 1896-1900.
15. Bengtsson C. The effect of metoprolol-a new selective adrenergic β1-receptor blocking agent in mild hypertension. Acta med scand, 1976, 199: 65-70.
16. Karlberg BE, Nilsson O. Once-daily metoprolol in primary hypertension. Clin Pharmacol Ther, 1979, 25(4): 399-407.
17. Asplund J, Ohman P. Metoprolol administered once daily in the treatment of hypertension. Annals of Clinical Research, 1981, 13(Suppl 30): 30-36.
18. Martin A, Browning RC. Metoprolol in the aged hypertensive: a comparison of two dose schedules. Postgraduate Medical Jorunal, 1985, 61: 225-227.
19. Feliciano N, Kasarjian PH. Safety and tolerability of metoprolol OROS in hypertension treatment. American Heart Journal, 1990, 490-494.
20. 靳婷. 美托洛爾常見(jiàn)不良反應(yīng)—神經(jīng)系統(tǒng)癥狀. 首都醫(yī)藥, 2006, 6: 31-32.
21. 中國(guó)高血壓防治指南修訂委員會(huì). 中國(guó)高血壓防治指南(2005年修訂版). 高血壓雜志, 2005, 134(增刊): 2-41.
22. Julie A, Johnson B, Robert N. Racial differences in adrenoceptor medinated responsiveness. Journal of Cardiovascular Pharmacology, 1995, 25(1): 90-96.
  1. 1. Gu FS. Progress on diagnosis and treatment of hypertension. Chinese Journal of Practical Internal Medicine, 2000, 20(1): 4.
  2. 2. Wang W, Liu LS. The relationship between blood pressure level and cerebral stroke recurrence—four-year follow up of 1520 patients with cerebrovascular diseases. Chinese Journal of Hypertension, 2003, 11: 106-108.
  3. 3. Wang W, Ma LY, Liu MB. Antihypertensive therapy is the key to prevent cardiovascular disease—a retrospective analysis of 29 randomized controlled trials. Chinese Journal of Medical Guide, 2004, 6(4): 259-261.
  4. 4. MOH, MOST, NBS. Survey on nutrition and health status of Chinese residents in 2002. Beijing: People’s Medical Publishing House, 2005. 1-25.
  5. 5. Liu M, Liu GP, Qi J. Metoprolol in the treatment of primary hypertension (210 cases report). Hainan Medical Journal, 2006, 17(11): 76.
  6. 6. Jin T. Common adverse reaction caused by metoprolol— nervous system symptom. Capital Medicine, 2006, 6: 31-32.
  7. 7. Chinese committee on guide of hypertension prevention and treatment. The guidelines for prevention and treatment of hypertension in China (revised edition 2005). Chinese Journal of Hypertension, 2005, 134(Suppl): 2-41.
  8. 8. 顧復(fù)生. 高血壓病診斷治療的最新進(jìn)展.中國(guó)實(shí)用內(nèi)科雜志, 2000, 20(1): 4.
  9. 9. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet, 1990, 335: 827-839.
  10. 10. 王文, 劉力生. 血壓水平與腦卒中再發(fā)的關(guān)系—1520例腦血管病患者隨訪4年. 高血壓雜志, 2003, 11: 106-108.
  11. 11. 王文, 馬麗媛, 劉明波. 降低血壓水平是預(yù)防心腦血管事件的關(guān)鍵——29項(xiàng)隨機(jī)對(duì)照降壓臨床試驗(yàn)回顧分析. 中國(guó)醫(yī)藥導(dǎo)刊, 2004, 6(4): 259-261.
  12. 12. 衛(wèi)生部, 科技部, 國(guó)家統(tǒng)計(jì)局. 中國(guó)居民營(yíng)養(yǎng)與健康狀況調(diào)查報(bào)告2002. 北京: 人民衛(wèi)生出版社, 2005. 1-25.
  13. 13. 劉敏, 劉光平, 祁健. 美托洛爾治療原發(fā)性高血壓210例臨床觀察. 海南醫(yī)學(xué), 2006, 17(11): 76.
  14. 14. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354: 1896-1900.
  15. 15. Bengtsson C. The effect of metoprolol-a new selective adrenergic β1-receptor blocking agent in mild hypertension. Acta med scand, 1976, 199: 65-70.
  16. 16. Karlberg BE, Nilsson O. Once-daily metoprolol in primary hypertension. Clin Pharmacol Ther, 1979, 25(4): 399-407.
  17. 17. Asplund J, Ohman P. Metoprolol administered once daily in the treatment of hypertension. Annals of Clinical Research, 1981, 13(Suppl 30): 30-36.
  18. 18. Martin A, Browning RC. Metoprolol in the aged hypertensive: a comparison of two dose schedules. Postgraduate Medical Jorunal, 1985, 61: 225-227.
  19. 19. Feliciano N, Kasarjian PH. Safety and tolerability of metoprolol OROS in hypertension treatment. American Heart Journal, 1990, 490-494.
  20. 20. 靳婷. 美托洛爾常見(jiàn)不良反應(yīng)—神經(jīng)系統(tǒng)癥狀. 首都醫(yī)藥, 2006, 6: 31-32.
  21. 21. 中國(guó)高血壓防治指南修訂委員會(huì). 中國(guó)高血壓防治指南(2005年修訂版). 高血壓雜志, 2005, 134(增刊): 2-41.
  22. 22. Julie A, Johnson B, Robert N. Racial differences in adrenoceptor medinated responsiveness. Journal of Cardiovascular Pharmacology, 1995, 25(1): 90-96.