| BackgroundHypertension is one of the most common chronic disease,especially in China, our overpopulated country,the incidence of hypertension is significantly higher.Hypertension also closely associates with cardiovascular risk and events.Reducing the blood pressure can reduce stroke, cardiovascular events, and so on, improve survival treatment, reduce the burden of life, and many other benefits.Along with the aging process,the incidence, morbidity and mortality of senile hypertension increased sharply, to family and the society brings great economic burden.There is a large number of elderly hypertension,so it should not be ignored, the elderly hypertension is not only a medical problem, but also a social problem.Beta blockers, usually for arrhythmia, heart failure, cardiomyopathy,coronary heart disease, and other fields, to control the heart rate, reduce cardiovascular events and protect target organs, the anti-hypertensive effect is not valued.But once the classic line of drug of anti-hypertensive treatment, in recent years has been controversial.Will we get rid of this kind of medicine from the drugs that the first-line treatment of hypertension ?A large number of the documents also point out:Compared with other anti-hypertensive drugs, beta blockers set of events more and less benefit from the elderly patients with high blood pressure, and less benefit for preventing stroke, reducing the mortality, but also can increase the risk of diabetes and so on.Most of the clinical trials are derived based on atenolol, but it is well known as short-acting water-soluble beta-blockers, can not fully represent the other beta blockers. The author select the clinical usage of larger, metoprolol, to study the metoprolol in patients with senile hypertension in anti-hypertension, protecting target organs and adverse reactions compared with the other anti-hypertensive agents and the other drugs of same class, evaluating metoprolol can be benefit for elderly patients with high blood pressure,and provide guidelines for rational use of clinical drug. ObjectiveUse the method of meta analysis to evaluate metoprolol and other types of anti-hypertension drugs and other drugs of same class in the elderly hypertension treatment to reduce systolic blood pressure, reduce the diastolic blood pressure,adverse reactions; The impact on the heart rate; Glucolipid metabolism, etc, thus evaluation of metoprolol in treating senile hypertension.To guide the clinical practice of the treatment of elderly hypertension. MethodsWe search metoprolol and other types of anti-hypertension drugs and other drugs of same class in the elderly hypertension treatment from The Cochrane Library, MEDLINE, Ebsco, Pubmed, Embase, CNKI, VIP, sino- med and Wanfang(2000-2015/Dec),and collect the curative effect of metoprolol and other anti-hypertensive drugs, metoprolol and other drugs of same classs in the treatment of elderly hypertension. Filter the literature according to the established factors.Extraction about the treatment, before and after the treatment systolic blood pressure, diastolic blood pressure, the heart rate, the number of adverse reactions, exit the test number, fasting blood glucose,blood lipid, and the quality evaluation of the literature, and then use RevMan 5.3 for Meta-- analysis. ResultsIn this Meta-- analysis,we summarized 12 trials including 1190 subjects which 593 from metoprolol treatment group and 597 from the control group.The results showed that:1, We have 11 trials including 1097 subjects,547 from the Metoprolol group and 550 from the control group in elderly hypertension of anti-hypertensive effect.Subgroup analysis shows:(1) Reduce systolic blood pressure:Compared with other types of anti-hypertension drugs(MD=1.66,95%CI:0.84~2.48,P<0.0001).Compared with other drugs of same class(MD=3.62,95%CI:2.49~4.75,P<0.00001).Metoprolol was not superior to other drugs in reducing SBP.(2) Reduce diastolic blood pressure:Compared with other types of anti-hypertension drugs(MD=0.67,95%CI:0.02~1.32,P=0.04).Compared with other drugs of same class(MD=1.39,95%CI:0.66~2.13,P=0.0002).Metoprolol was not superior to other drugs in reducing DBP.(3)The anti-hypertensive effective rate:Compared with other types of anti-hypertension drugs(OR=1.26,95%CI:0.78~2.01,P=0.35).There was no statistical difference.2,There are 5 trials including 419 subjects,208 from the Metoprolol group and 211 from the control group in elderly hypertension of fasting blood-glucose(FBG).The result:(MD=0.02,95%CI:-0.13~0.17,P=0.81). There was no statistical difference.3, In the adverse reaction:The 12 trials,and the result is:(OR=0.73,95%CI:0.44~1.20,P=0.22).There was no statistical difference.4,In the blood lipid metabolism:There were 3 trials including 186 subjects,92 from the Metoprolol group and 94 from the control group in elderly hypertension of blood lipid metabolism.Subgroup analysis shows:(1) About Triglyceride(TG):(MD=0.01,95%CI-0.18~0.20,P=0.92).There was no statistical difference.(2) About total cholestrol(TC):(MD=0.33,95%CI-0.35~0.14,P=0.10).There was no statistical difference.(3) About low density lipoprotein cholesterol(LDL-C):(MD=-0.11,95%CI-0.35~0.14,P=0.40).There was no statistical difference.(4) About high density lipoprotein cholesterol(HDL-C):(MD=-0.02,95%CI-0.14~0.10,P=0.73).There was no statistical difference. ConclusionMetoprolol compared with other types of anti-hypertension drugs and other drugs of same class in the elderly hypertension treatment, Metoprolol was not superior to other drugs in anti-hypertensive effect,But its anti-hypertensive efficacy was still obvious,and had no affect in the fasting plasma glucose,in the blood lipid metabolism. The anti-hypertensive effective rate and the adverse reaction,there was no statistical difference from others.Therefore, metoprolol in the treatment of elderly hypertension whether can be used as first-line drugs, this meta-analysis did not draw a clear conclusion, the clinical data should have been needed for further proofing. |
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