| Objective: To evaluate whether it is superior to apply amlodipine(single drug,fixed-dose) in Chinese elderly hypertensive patients by adopting the Meta-analysis method and to provide basis for application of amlodipine in this special group.Methods: Used computer to search the statistics about randomized controlled trials(RCT) of amlodipine using in the Chinese elderly hypertensive patients. According to the pre-specified inclusion and exclusion criteria, selected documents which conform to the requirements. Exercised strict quality assessment of these included documents and extracted data from the included documents(cardiovascular events, systolic blood pressure(SBP), diastolic blood pressure(DBP), adverse events and antihypertensive effective rate). Then used Rev Man5.3 software to conduct statistical analysis. In this study,I2>50% means the heterogeneity unacceptable,when the heterogeneity can be accepted,we use fixed effect model.when the heterogeneity can not be accepted,we analyse the source of heterogeneity(using subgroup analysis). If the heterogeneity can not be eliminated, we use the random effects model to process the data.Results: There were 2870 articles retrieved in total, of which 2837 articles were excluded after having a look at the title, abstract and reading full texts. Finally, 37 studies were included in the study(cases of amlodipine: 1721 cases in the control group: 1709).Amlodipine compared with other antihypertensive drugs,the results showed that:1. The antihypertensive effective rate: Compared with other antihypertensive drugs [OR =1.34,95%CI(1.11,1.61),Z=3.06,P=0.002],P≤0.05,There was statistical difference.Subgroup analysis showed:amlodipine was better than nifedipine(short-acting agents) [OR=2.78,95%CI(1.52, 508), Z=3.32, P=0.0009],better than metoprolol [OR=1.58, 95% CI(1.00,2.51), Z=1.94, P=0.05], P≤0.05. There were statistical difference.2. The incidence rate of adverse events: the incidence rate of amlodipine adverse events was lower than other antihypertensive drugs [OR =0.61,95%CI( 0.44,0.86), Z=2.87,P=0.004], P ≤ 0.05,There were statistical difference. Subgroup analysis showed that amlodipine adverse events rate was lower than nifedipine(short-acting agents) [OR=0.23,95%CI(0.13 and 0.44). Z=4.50, P = 0.00001],P≤0.05,There were statistical difference.3. Decrease of systolic pressure: decrease in systolic pressure of amlodipine was better than other antihypertensive drugs [MD=-2.93,95%CI(-5.85,-0.02),Z=1.97,P=0.05],P≤0.05,There were statistical difference. Subgroup analysis showed that amlodipine was better than nifedipine(short-acting agents) [MD =-6.59,95%CI(-11.09,-2.09),Z=2.87,P=0.004], better than irbesartan(4 weeks treatment) [MD=-3.26,95%CI(-5.12,-1.40), Z=3.44, P=0.0006], and better than enalapril(amlodipine 10 mg per capita dose) [MD=-2.49,95%CI(-4.78,-0.19, Z=2.12, P = 0.03] P≤0.05, There were statistical difference.4. Decrease of diastolic pressure: decrease in diastolic pressure of amlodipine was not better than other antihypertensive drugs[MD=-0.85,95%CI(-2.49,0.79), Z=1.02,P=0.31], P>0.05,There was no statistical difference.Subgroup analysis showed that amlodipine was better than valsartan [MD=-1.19, 95% CI(2.18,-0.20), Z=2.37.], better than nifedipine(short-acting agents) [MD=-5.07, 95% CI(-8.11,-2.03), Z=3.27, P = 0.001), P≤0.05, There were statistical difference.Conclusion:1. The antihypertensive effective rate of amlodipine was better than nifedipine(short-acting agents) and metoprolol.2. The incidence rate of adverse events of amlodipine was lower than nifedipine(short-acting agents). 3. Systolic pressure decrease of amlodipine was better than nifedipine(short-acting agents),better than irbesartan(4 weeks’ treatment) and enalapril(amlodipine 10 mg per capita dose). 4. Diastolic blood pressure decrease of amlodipine was better than valsartan and nifedipine(short-acting agents). 5. Amlodipine had certain advantages in elderly hypertensive patients. |
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