Meta-analysis of different angiotension converting enzyme inhibitors in the treatment of hypertension
Objective To systematically evaluate the antihypertensive efficacy and cough induced adverse reactions of imidapril and other angiotensin-converting enzyme inhibitors(ACEI).Methods PubMed,Cochrane,CNKI,WanFang Data and other databases were used to search the published literatures of randomized controlled trials(RCTs)involving the use of imidapril hydrochloride tablets and other ACEI drugs in the treatment of hypertension at home and abroad.The search deadline was December 2022.Two investigators independently screened the literature,extracted the data,and assessed the risk of bias in the included studies.Fixed or random effects models were used to summarize the study results,and RevMan5.3 was used to complete the Meta-analysis and draw the forest map.The efficacy and safety of imidapril hydrochloride tablets in the treatment of hypertension were systematically evaluated by the indexes of antihypertensive efficiency and adverse reactions to dry cough.Results A total of 12 articles were included in this study,with a total of 2 173 subjects.The results of meta-analysis showed that:① Effective rate:There was no significant difference in the effective rate of midapril hydrochloride tablets in the treatment of hypertension compared with captopril,perindopril,cilapril and enalapril groups[80.5%vs.73.4%,RR=1.06,95%CI(0.97,1.15),P=0.22].② Adverse drug reactions:The incidence of adverse reactions of imidapril hydrochloride tablets in the treatment of hypertension was significantly lower than that of enalapril and captopril,with statistical significance[10.7%vs.17.8%,RR=0.51,95%CI(0.32,0.83),P=0.006;15.4%vs.33.3%,RR=0.47,95%CI(0.27,0.84),P=0.05].③Incidence of dry cough:The incidence of dry cough adverse reactions of imidapril hydrochloride tablets in the treatment of essential hypertension or renal parenchymal hypertension was significantly lower than that of benazepril,captopril,cillapril and enalapril,with statistical significance[5.2%vs.13.9%,RR=0.37,95%CI(0.25,0.54),P＜0.000 01;8.6%vs.21.6%,RR=0.40,95%CI(0.25,0.65),P=0.000 2;13.8%vs.25.5%,RR=0.54,95%CI(0.31,0.95),P=0.03;6.9%vs.15.5%,RR=0.42,95%CI(0.27,0.65),P=0.001].Compared with perindopril,imidapril had a slightly lower incidence of dry cough,but the difference was not statistically significant[11.3%vs.12.6%,RR=0.90,95%CI(0.43,1.88),P=0.77].Conclusion The antihypertensive effect of imidapril hydrochloride tablets is similar to that of captopril,perindopril,cillapril and enalapril,but the incidence of dry cough is significantly lower than that of benazepril,captopril,cillapril and other ACEI drugs,which has better clinical application advantages.
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