鈣離子阻斷劑Nifedipine與Amlodipine降血壓效果比較之統合分析(實證醫學)

Meta-Analysis for Comparison of Calcium Channel Blockers in Nifedipine With Amlodipine (Evidence-Based Medicine)

張益通(Yi-Tung Chang)

指導教授 ： 蔡崇弘

中山醫學大學/醫學院/醫學研究所/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00101

摘要

研究背景: 根據國內用藥使用量統計，降血壓藥品是使用量統計最高的藥品。台灣單方藥品銷售排行前二十名的藥品中，降血壓藥就佔五名之多，這五大降血壓藥一年銷售金額更達六十億新台幣以上，銷售量接近三億顆，平均每天總共吃掉超過八十萬顆降血壓藥。由於高血壓是引起中風和冠狀動脈心臟病的重要原因之一，規律的吃藥控制血壓非常重要，再加上高血壓無法根治，必須長期控制，因此降血壓藥在高齡化社會的使用量相對的就非常大！降血壓藥品中的鈣離子阻斷劑更是高血壓用藥中用量最大的類別，其中Nornasc連續幾年高居榜首，而另一鈣離子阻斷劑Adalat使用量僅次之。Adalat劑型設計上為外表使用科技薄膜，利用雷射孔持續釋放出有效成分，達到長效緩釋穩定控制血壓的功能。藥動學上應比Norvasc較佳，但實際處方數量上卻不同，反而Norvasc比較多。研究目的: 運用實證醫學手法，利用文獻蒐集加以分析，了解各研究統合之結果。研究方法: 文獻搜尋方法將利用線上實證醫學資料庫Medline OVID、Pumed等搜尋，經過文獻的評讀，加以篩選適當之文獻資料，再以統合分析軟體加以分析得知結果。本研究將採用統合分析的方法，回顧所有相關臨床試驗，並運用統計的方法來整合所有個別研究結果。研究結果: 最後本次研究總共納入11個隨機對照試驗，整理出我們想比較的影響效果後，運用統合分析軟體RevMan軟體來獲得統計的結果。結果顯示兩種鈣離子阻斷劑amlodipine、nifedipine在降血壓上的比較，首先在下降收縮血壓比較上，因為統計分析軟體森林圖最終結果跨越無效中線，表示兩種藥物對於收縮壓的下降影響差異不大。另外在舒張血壓比較上，森林圖結果仍然跨越無效中線，同時也表示兩種藥物對於高血壓患者舒張壓的下降程度是皆有效且無差異的。結論: 根據統合分析軟體的分析結果，兩種鈣離子阻斷劑對於高血壓患者收縮壓或舒張壓的下降皆是有效且效果相似的，對於臨床上用藥建議仍是有所幫助，效果相同之下，用藥上就只需考量其它方面，例如劑型使用上或患者耐受性等。分析結果可應用於臨床治療上，讓我們選擇對患者最佳的醫療照護。

關鍵字

高血壓 ； 鈣離子阻斷劑

並列摘要

Background :According to statistics, the blood pressure lowering drugs is the best selling drug in Taiwan. Taiwan ranked top 20 selling drugs in lowering blood pressure drug accounted for five, the five major antihypertensive drug annual sales of more than 6.5 billion yuan, sales approaching three hundred million, people eat more than eighty per day ten thousand blood pressure lowering drugs. Because hypertension is caused by stroke and coronary heart disease is one important reason, the law is very important to take medicine to control blood pressure, coupled with high blood pressure can not cure, must be long-term control medication, the blood pressure lowering drug use in an aging society amazing amount of big!Including calcium channel blockers is the largest amount of high blood pressure medication category, nornasc topped the list for several years, another calcium channel blocker compound adalat OROS use the next best. Dosage form design technology for the film, the use of laser hole sustained release of active ingredients to achieve long-term stable control of blood pressure-release function. Pharmacokinetics should be better than norvasc, but the actual prescription is different.Objective: So I hope the use of evidence-based medicine practices, the use of literature collected to be analyzed to understand the integration of the research results.Methods: Literature search for evidence-based medicine approach to the use of online databases Medline OVID, Pumed other search through the literature of the appraisal, to filter appropriate documentation, then meta-analysis software to analyze the results of that.Results: We included 11 randomized controlled clinical trials into our study, compared the hypertensive effect between these two calcium channel blockers amlodipine and nifedipine, and use the meta-analysis software “RevMan software” to get the survey results. The results shown that regarding to lowering the systolic blood pressure, the forest plot across the broken center line, revealed that lowering the systolic blood pressure had not significant difference between amlodipine and nifedipine. And regarding to lowering the diastolic blood pressure, the forest plot also across the broken center line, revealed that lowering the diastolic blood pressure had not significant difference between amlodipine and nifedipine.Discussion: The results from meta-analysis software, we could find that the decline in systolic or diastolic blood pressure between amlodipine and nifedipine had similar hypertensive effect. It is helpful for clinical prescription proposal. Based on the similar hypertensive effect, we should consider other factors, like the dosage form and patient’s tolerance. It can be applied to clinical treatment decision to chose a suitable calcium channel blockers.

並列關鍵字

Hypertension ； Calcium channel blockers ； Dihydropyridine ； Amlodipine ； Nifedipine

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