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SGLT2i对2型糖尿病合并高血压患者24 h动态血压影响的荟萃分析
Effects of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes complicating hypertension: a meta-analysis

查看参考文献26篇

田丽 1   王琼英 1 *   孙润民 1,2   齐苗苗 1,2   李亚欣 3   高欣 3   张丽琼 3   马雪 4   石航 4   余静 1,2   白锋 1,2  
文摘 目的探究不同种类的钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)对2型糖尿病合并高血压患者24h动态血压的影响。方法该研究为荟萃分析。搜索有关SGLT2i对2型糖尿病合并高血压患者24 h动态血压影响的随机对照试验。搜索的数据库有3个,即美国国立医学图书馆数据库(PubMed)、Web of Science和Cochrane循证医学数据库(Cochrane Library)。搜索分为3个概念组,第1组包含用于描述SGLT2i的术语,第2组包含与血压相关的术语,第3组包含描述随机对照试验的术语。检索时间从数据库建立至2020年12月。按照Cochrane系统评价要求制定纳入、排除标准。根据研究的异质性是否显著,分别采用随机效应模型及固定效应模型进行荟萃分析,分析不同种类SGLT2i对2型糖尿病合并高血压患者24 h动态血压以及日间和夜间血压的影响。进一步对根据可能导致临床异质性的因素进行亚组分析。结果荟萃分析结果显示,与安慰剂比较,SGLT2i可使2型糖尿病合并高血压患者24 h动态收缩压降低4.36 mmHg(1 mmHg=0.133 kPa),卡格列净、达格列净、恩格列净和艾格列净分别可使其降低4.59、3.74、5.06和3.64 mmHg。荟萃分析结果显示,与安慰剂比较,SGLT2i可使2型糖尿病合并高血压患者24 h动态舒张压降低2.20 mmHg,卡格列净、达格列净、恩格列净和艾格列净可分别使其降低2.30、1.22、2.00和2.69 mmHg。荟萃分析结果显示,与安慰剂比较,SGLT2i可使2型糖尿病合并高血压患者日间收缩压降低5.25 mmHg,卡格列净、达格列净、恩格列净和艾格列净可分别使其降低5.38、4.87、6.00和4.37 mmHg。同时,与安慰剂比较,SGLT2i可使2型糖尿病合并高血压患者日间舒张压降低2.62 mmHg,卡格列净、恩格列净和艾格列净可分别使其降低2.56、2.47和2.80 mmHg。荟萃分析结果显示,与安慰剂比较,SGLT2i可使2型糖尿病合并高血压患者夜间收缩压降低3.62 mmHg,卡格列净、达格列净、恩格列净和艾格列净可分别使其降低2.09、2.06、3.92和2.45 mmHg。同时,SGLT2i可使2型糖尿病合并高血压患者夜间舒张压降低1.60 mmHg,卡格列净、恩格列净和艾格列净可分别使其降低1.51、1.53和2.58 mmHg。结论SGLT2i可降低2型糖尿病合并高血压患者24 h动态血压。
其他语种文摘 Objective To analyze the effects of different types of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on 24-hour ambulatory blood pressure in patients with type 2 diabetes mellitus and hypertension. Method In this meta-analysis, we searched for randomized controlled trials on the effect of SGLT2i on 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension. Three databases, namely PubMed, Web of Science and Cochrane Library, were searched. The search was organized on the concept of 3 conceptual groups: the first group contained terms used to describe SGLT2i, the second group contained terms related to blood pressure, and the third group contained terms used to describe randomized controlled trials. The search time was from the establishment of the database to December 2020. The inclusion and exclusion criteria were formulated in accordance with the requirements of the Cochrane systematic review. According to whether the heterogeneity of the study was significant or not, a random effect model or a fixed effect model were used to conduct the analysis on the impact of different types of SGLT2i on 24-hour ambulatory blood pressure and day and night blood pressure in patients with type 2 diabetes and hypertension. Further subgroup analysis was performed to define potential factors, which might lead to clinical heterogeneity. Results Seven clinical trials were finally included. The result of the meta-analysis showed that compared with placebo group, SGLT2i could reduce the 24-hour dynamic systolic blood pressure of patients with type 2 diabetes and hypertension by 4.36 mmHg (1 mmHg=0.133 kPa). Reduction was 4.59, 3.74, 5.06, and 3.64 mmHg by canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin respectively; SGLT2i could reduce the 24-hour dynamic diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.20 mmHg, and the reduction was 2.30, 1.22, 2.00, and 2.69 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin respectively. SGLT2i could reduce the daytime systolic blood pressure of patients with type 2 diabetes and hypertension by 5.25 mmHg, and reduction was 5.38, 4.87, 6.00, and 4.37 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. Simultaneously, SGLT2i could reduce the diastolic blood pressure of patients with type 2 diabetes and hypertension by 2.62 mmHg, and the reduction was 2.56, 2.47, and 2.80 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. SGLT2i could reduce the nighttime systolic blood pressure of patients with type 2 diabetes and hypertension by 3.62 mmHg, and the reduction was 2.09, 2.06, 3.92, and 2.45 mmHg by canagliflozin, dapagliflozin, empagliflozin and ertugliflozin, respectively. At the same time, SGLT2i could reduce the nighttime diastolic blood pressure of patients with type 2 diabetes and hypertension by 1.60 and 1.51 mmHg, the reduction was 1.53 and 2.58 mmHg by canagliflozin, empagliflozin and ertugliflozin, respectively. Conclusion SGLT2i can reduce 24-hour ambulatory blood pressure in patients with type 2 diabetes and hypertension.
来源 中华心血管病杂志 ,2021,49(10):1000-1011 【核心库】
DOI 10.3760/cma.j.cn112148-20210127-00098
关键词 高血压 ; 糖尿病 ; 钠-葡萄糖协同转运蛋白2抑制剂
地址

1. 兰州大学第二医院心血管内科, 730030  

2. 兰州大学第二医院心血管实验室, 730030  

3. 兰州大学第二临床医学院, 730030  

4. 西北民族大学医学部, 兰州, 730030

语种 中文
文献类型 研究性论文
ISSN 0253-3758
学科 医药、卫生
基金 甘肃省卫生行业项目 ;  兰州大学第二医院萃英科技创新计划 ;  兰州大学第二医院萃英学子科研培育计划
文献收藏号 CSCD:7081623

参考文献 共 26 共2页

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引证文献 2

1 中国高血压联盟《夜间高血压管理中国专家共识》委员会 夜间高血压管理中国专家共识 中华高血压杂志,2023,31(7):610-618
被引 0 次

2 杨帆 SGLT2抑制剂对糖尿病相关心律失常发生的影响及其机制的研究进展 中华心血管病杂志,2023,51(8):887-891
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