Meta-analysis of the efficacy and safety of febuxostat in the treatment of hyperuricemia with hypertension
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目的 评价非布司他在高尿酸血症伴高血压治疗中的疗效及安全性.方法 按检索策略在Medline、Web of Science、Cochran library、Embase、中国知网(CNKI)、万方数据库、维普数据库中检索关于非布司他治疗高尿酸血症伴高血压的随机对照试验(RCT)相关文献,检索时限从2013年1月至2023年7月.由经过系统化培训的2名研究者完成文献筛选、质量评价及数据提取工作.采用RevMan5.3进行Meta分析.采用固定效应模型或随机效应模型分析数据,并通过亚组分析寻找异质性来源.结果 最终纳入5篇RCT相关文献行Meta分析,均为英文文献、国外研究,共计456例患者,试验组228例,对照组228例.在高尿酸血症伴高血压治疗中,非布司他相比于对照药物对sUA水平的降低差异有统计学意义[均数差(95％CI)=-1.31(-2.55,-0.07),P=0.040],收缩压的降低差异无统计学意义[标准化均数差(95％CI)=-0.12(-0.51,0.27),P=0.540],舒张压的降低差异无统计学意义[SMD(95％CI)=-0.15(-0.40,0.09),P=0.220].亚组分析显示,对照组干预药物不同可能是血清尿酸水平异质性存在的原因;干预时间的差异可能是不同研究间收缩压水平存在异质性的原因.非布司他组与对照组的不良反应率比较差异无统计学意义[危险度差异(95％CI)=-0.01(-0.08,0.06),P=0.770].结论 非布司他在高尿酸血症伴高血压的治疗中,对血清尿酸的改善有明显优势,且安全性较好,但对血压的控制无显著优势.
Objective To evaluate the efficacy and safety of febuxostat in the treatment of hyperuricemia with hypertension.Methods Randomized controlled trials(RCT)on the treatment of hyperuricemia with hypertension using febuxostat were retrieved from Medline,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Database,and VIP Database from January 2013 to July 2023,according to the retrieval strategy.Two trained researchers completed the literature screening,quality evaluation,and data extraction.Meta-analysis was performed using RevMan 5.3.The fixed-effect model or random-effects model was used to analyze the research data,and subgroup analysis was conducted to identify the source of heterogeneity.Results A total of 5 RCTs involving 456 patients(228 in the experimental group and 228 in the control group)were included in the meta-analysis,all of which were English-language literatures and foreign studies.In the treatment of hyperuricemia with hypertension,febuxostat showed a statistically significant difference in reducing serum uric acid(sUA)levels compared to control drugs[MD(95％CI)=-1.31(-2.55,-0.07),P=0.040];there was no statistically significant difference in reducing systolic blood pressure(SBP)[SMD(95％CI)=-0.12(-0.51,0.27),P=0.540]or diastolic blood pressure(DBP)[SMD(95％CI)=-0.15(-0.40,0.09),P=0.220].Subgroup analysis showed that the difference in intervention drugs in the control group may be the cause of heterogeneity in sUA levels,and the difference in intervention time may be the cause of heterogeneity in SBP levels among different studies.There was no statistically significant difference in the incidence of adverse reactions between the febuxostat group and the control group[RD(95％CI)=-0.01(-0.08,0.06),P=0.770].Conclusion Febuxostat has a significant advantage in improving sUA levels and is relatively safe in the treatment of hyperuricemia with hypertension,but it does not show significant advantages in blood pressure control.
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