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目的 从循证医学角度评价国内 8种血管紧张素转换酶抑制剂 (普利类降压药 )对高血压患者的临床疗效、安全性、成本 效果、依从性及伦理学等。 方法 采用药物卫生技术评估方法 ,检索Medline、Cochrane图书馆、Embase和中国生物医学文献数据库 (CBMdisc)等数据库 ,疗效分析纳入系统评价、随机临床对照试验和交叉试验等 ;安全性和药物经济学分析同时纳入观察性研究。按国际评价标准严格评价文献 ,纳入高质量研究。 结果 8种普利类降压药的降压幅度与剂量呈正相关 ;任何一种普利类降压药与钙拮抗剂或利尿剂或受体阻滞剂联合应用 ,降压效果更佳 ;新型普利类降压药的作用强于依那普利和卡托普利。Meta 分析显示 ,谷 峰比值小于 5 0 %的有培哚普利、贝那普利和卡托普利。上述 8种普利类降压药均有关于心脏保护的研究证据。慢性心力衰竭 ,依那普利和卡托普利的高质量研究证据最多 ;赖诺普利、培哚普利、西拉普利和贝那普利仅观察了中间指标对心力衰竭的影响。心脏保护 ,福辛普利较卡托普利更安全 ,比依那普利效果好 ;赖诺普利优于卡托普利等均以替代指标进行比较。治疗心肌梗死 ,证据显示卡托普利和赖诺普利可降低急性期 (心肌梗死 3 6h内 )患者病死率 ;依那普利、卡托普利、雷米普利和培哚普利可明显降低
Objective To evaluate the clinical efficacy, safety, cost effectiveness, compliance and ethics of 8 kinds of angiotensin-converting enzyme inhibitors (Puli class antihypertensive drugs) in hypertensive patients from the perspective of evidence-based medicine. Methods Using the method of medical health assessment, the databases of Medline, Cochrane Library, Embase and CBMdisc were searched, and the efficacy analysis was included in the systematic reviews, randomized controlled trials and crossover trials. Safety and pharmacoeconomic analysis At the same time included in observational studies. Strict evaluation of the literature according to international assessment criteria, incorporating high quality research. Results The depressurization amplitude of 8 kinds of Pulitzer antihypertensive drugs was positively correlated with the dosage. Any kind of Pulitzer antihypertensive drugs combined with calcium antagonist or diuretic drug or blocker had a better antihypertensive effect. Puli class of antihypertensive drugs stronger than enalapril and captopril. Meta-analysis showed that perindopril, benazepril and captopril were less than 50%. The 8 kinds of Pulitzer antihypertensive drugs have research evidence on the protection of the heart. Chronic heart failure, enalapril and captopril have the most evidence of high-quality research; lisinopril, perindopril, cilazapril, and benazapril only observe the effects of intermediate measures on heart failure. Cardiac protection, fosinopril is more secure than captopril, better effect than enalapril; lisinopril better than captopril, etc. were compared with alternative indicators. Treatment of myocardial infarction, evidence that captopril and lisinopril can reduce mortality in patients with acute phase (within 36 h of myocardial infarction); enalapril, captopril, ramipril and perindopril can be significantly reduced