• 四川大學華西醫(yī)院老年科 （成都 610041）;

目的　 系統(tǒng)評價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)性高血壓的隨機對照試驗（RCT）與自身前后對照試驗，根據(jù)納入和排除標準篩選文獻、提取資料和進行質(zhì)量評價，并用RevMan 4.2.8軟件對數(shù)據(jù)進行Meta分析。
結(jié)果　 共納入5個試驗，其中2篇為較高質(zhì)量研究，3篇為低質(zhì)量研究。5篇文獻均未報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篇文獻報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準差。對其中兩篇不同劑量自身前后對照試驗治療后的收縮壓及舒張壓水平進行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篇文獻報告了不良反應(yīng)，對不同劑量治療后非特異性不良反應(yīng)發(fā)生率進行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，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，可根據(jù)患者耐受性個體化用藥，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價. 中國循證醫(yī)學雜志, 2007, 07(11): 802-809. doi: 復(fù)制

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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展.中國實用內(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項隨機對照降壓臨床試驗回顧分析. 中國醫(yī)藥導刊, 2004, 6(4): 259-261.
12. 衛(wèi)生部, 科技部, 國家統(tǒng)計局. 中國居民營養(yǎng)與健康狀況調(diào)查報告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, 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. 中國高血壓防治指南修訂委員會. 中國高血壓防治指南(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展.中國實用內(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項隨機對照降壓臨床試驗回顧分析. 中國醫(yī)藥導刊, 2004, 6(4): 259-261.
  12. 12. 衛(wèi)生部, 科技部, 國家統(tǒng)計局. 中國居民營養(yǎng)與健康狀況調(diào)查報告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, 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. 中國高血壓防治指南修訂委員會. 中國高血壓防治指南(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.