A METAANALYSIS OF THE EFFECTS OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS ON BLOOD-PRESSURE
A METAANALYSIS OF THE EFFECTS OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS ON BLOOD-PRESSURE
复制标题
DOI：
10.1001/archinte.153.4.477
复制
发表时间：
1993-02-22
影响因子：
--
通讯作者：
FELSON, DT
中科院分区：
文献类型：
--
作者：
POPE, JE;ANDERSON, JJ;FELSON, DT
背景：非甾体抗炎药（NSAID）具有众所周知的胃肠道和肾脏毒性反应。非甾体抗炎药对血压的影响尚不为人所知。进行荟萃分析以确定 NSAID 的高血压作用，并根据平均动脉压 (MAP) 的变化幅度对它们进行排名。方法：对已发表的 NSAID 及其对血压影响的英文研究进行文献检索。符合以下标准的研究被纳入：（1）研究为干预研究； (2) 包括任何剂量的非甾体抗炎药或1.5克/天或更大剂量的阿司匹林； (3) 提供血压记录； (4) 研究持续 24 小时。如果 20% 或更多的参与者退出，或者在受试者服用 NSAID 时调整抗高血压药物的剂量，则研究被排除。主要结果是患者接受 NSAID 治疗时 MAP 的变化。每个 NSAID 组均从其试验中提取出来。记录可能的混杂因素的信息，包括受试者年龄、试验质量、膳食盐摄入量以及研究受试者是否高血压或正常血压。我们计算了每种 NSAID 的 MAP 平均变化，并调整了混杂因素。结果：涉及 123 个 NSAID 治疗组的 54 项研究符合纳入标准。受试者的平均年龄为 46 岁。在 1324 名参与者中，1213 名受试者 (92%) 患有高血压。仅在高血压受试者中发现了非甾体抗炎药对血压的影响。其中，调整膳食盐摄入量后，MAP 增加量为：吲哚美辛（57 个治疗组）为 3.59 mm Hg，萘普生为 3.74 mm Hg（4 个治疗组），吡罗昔康为 0.49 mm Hg（4 个治疗组）。安慰剂（10 组）的 MAP 降低了 2.59 mm Hg，布洛芬（6 组）降低了 0.83 mm Hg，阿司匹林（4 组）降低了 1.76 mm Hg，舒林酸（23 组）降低了 0.16 mm Hg。使用安慰剂、舒林酸和阿司匹林对 MAP 的影响与吲哚美辛有统计学上的显着差异。 结论：在短期使用中，非甾体抗炎药对血压的影响差异很大。在所研究的药物中，吲哚美辛和萘普生与血压升高幅度最大。吡罗昔康、阿司匹林、布洛芬和舒林酸的平均作用可以忽略不计。
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) have well-known gastrointestinal and renal toxic reactions. Effects of NSAIDs on blood pressure are less appreciated. A meta-analysis was performed to determine the hypertensive effects of NSAIDs and rank them by magnitude of change in mean arterial pressure (MAP).Methods: A literature search of published English-language studies of NSAIDs and their effects on blood pressure was done. Studies were included if they met the following criteria: (1) the studies were intervention studies; (2) NSAIDs at any dose or aspirin at doses of 1.5 g/d or greater were included; (3) documentation of blood pressure was provided; and (4) the studies were 24 hours in duration. Studies were excluded if 20% or more of their participants dropped out or if the dose of antihypertensive drugs was adjusted while the subjects were taking NSAIDs. The major outcome was change in MAP while patients were receiving NSAIDs. Each NSAID arm was extracted from its trial. Information on possible confounders, including subject age, trial quality, amount of dietary salt intake, and whether study subjects were hypertensive or normotensive, was recorded. We calculated the average change in MAP on each NSAID, adjusting for confounders.Results: Fifty-four studies with 123 NSAID treatment arms met inclusion criteria. The mean age of subjects was 46 years. Of the 1324 participants, 1213 subjects (92%) were hypertensive. The effects of NSAIDs on blood pressure were found solely in hypertensive subjects. Among these, the increase in MAP after adjusting for amount of dietary salt intake was 3.59 mm Hg for indomethacin (57 treatment arms), 3.74 mm Hg for naproxen (four arms), and 0.49 mm Hg for piroxicam (four arms). The MAP decreased by 2.59 mm Hg for placebo (10 arms), 0.83 mm Hg for ibuprofen (six arms), 1.76 mm Hg for aspirin (four arms), and 0.16 mm Hg for sulindac (23 arms). The effects on MAP by using placebo, sulindac, and aspirin were statistically significantly different from indomethacin.Conclusions: In short-term use, NSAIDs vary considerably in their effect on blood pressure. Of the drugs studied, indomethacin and naproxen were associated with the largest increases in blood pressure. The average effects of piroxicam, aspirin, ibuprofen, and sulindac were negligible.