| Background:High blood pressure refers to systemic arterial systolic and (or) diastolic blood pressure continuing to rise as the main features of a systemic disease. Hypertension is the most common chronic disease, risk factors of cardiovascular and cerebrovascular disease,the most important complications of which are stroke, myocardial infarction, heart failure and chronic kidney disease and the others.Not only does it lead disability, death rate, but also a serious drain it is on the medical and social resources, a heavy burden to the family and the state.According to the2002survey data, the adult hypertension prevalence was18.8%, it is estimated that in China there are about200million patients with hypertension, there are two of every10adults having hypertension, accounting for1/5of the total number all over the world. According to statistics, China has almost130million patients with hypertension who do not know they are suffering from high blood pressure, To the crowd that are suffering from high blood pressure, about30million are out of treatment; in patients receiving antihypertensive therapy,75%of which do not reach the target level.Practices at home and abroad have proved that hypertension is a disease under prevention and control.Reducing hypertension in patients with high blood pressure level, can significantly reduce stroke and heart disease events, and significantly improve patients’ quality of life and reduce the burden of disease.Drug treatment is an indispensable part of antihypertensive therapy. The commonly used antihypertensive drugs include calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), diuretics, and β-blockers. And in the new version "2010Hypertension Prevention Guide ",which highlights fixed ratio of these drugs. In addition, α-blockers and other types of antihypertensive drugs can sometimes be applied to certain hypertensive population.β-Blockers have been widely used in various fields of clinical medicine since the1960s. In the treatment of heart failure (HF),hypertension, coronary heart disease, arrhythmia, cardiomyopathy, β-blockers played the important role, and they have become one of the most widely used cardiovascular drugs.The antihypertensive mechanism of β-blockers is:reducing cardiac output, the inhibition of the releasing of renin and angiotensin,blocking the epinephrine synapses receptors, and so on.As a kind of antihypertensive drugs, β-blockers are extensively used in China,.In recent years, the most widely used are fumarate bisoprolol (Kang Xin) and metoprolol tartrate (Betaloc). With the rapid development of the inquired medicine, there are many experiments and meta-analysis about bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in the treatment of coronary artery disease, heart failure and other aspects. Inquired medical experiments and meta-analysis of the two drugs in the treatment of high blood pressure are more concerned about the comparison of the difference of the blockers in the incidence of cardiovascular events.But for the comparison of bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in antihypertensive efficacy (including the decline of systolic blood pressure, diastolic blood pressure, the overall drop in blood pressure), the decline of heart rate, the impact of adverse events rate, there are still only a few small-scale, randomized clinical trials, and the large-scale clinical trials and related meta-analysis are lack. We can not provide a full inquiry with the antihypertensive efficacy and safety of medical data about bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc). Thus we can not provide a reliable and systematic theoretical support for the clinical pharmacists in rational use of the drug for now and in the future.Objective:With the experimental method established,we compare fumarate bisoprolol (Kang Xin) and metoprolol tartrate (Betaloc) in the antihypertensive effects (including the decline of systolic blood pressure, diastolic blood pressure, and the overall blood pressure), the incidence of the adverse reactions,and the decline of the heart rate.Methods:We use CNKI, Articles, VIP, CBM database retrieved from1995to2011about bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc)(including randomized controlled clinical research, and related meta-analysis, etc.), through evaluation of the experiments’ quality, according to the pre-defined criteria of the relevant studies, extract the relevant patient’s medication, the data of the pre-treatment systolic blood pressure, diastolic blood pressure, heart rate level; the systolic blood pressure, diastolic blood pressure, heart rate level after treatment; and the data of adverse reaction rate.Then we use Revman5.0.21software Meta-analysis to compare bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in the antihypertensive effects (including the decline of systolic blood pressure, diastolic blood pressure, and the overall blood pressure), and the incidence of the adverse reactions,and the decline of the heart rate under the requirements and the method established.Results:This Meta-analysis includes six clinical studies,557patients. JADAD scores are greater than or equal to4. The results show that:under the methodology established, bisoprolol fumarate (Kang Xin) shows a higher efficiency in controlling blood pressure (189/215vs.161/203), the OR value (95%CI):1.92[1.13,3.29], P=0.02; there is no significant difference between bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in lowering systolic blood pressure:WMD (95%CI):-2.14[-7.24,2.96], P=0.41; there is no significant difference between bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in lowering diastolic blood pressure:WMD (95%CI):-0.18[-1.33,0.97], P=0.76.There is no significant difference between bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in lowering heart rate:WMD (95%CI):0.87[-0.51,2.26], P=0.22;there is no significant difference between bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in the incidence of adverse reactions:(16/165vs.15/155), the OR value (95%CI):1.01[0.48,2.12], P=0.98.Because in the article of hua-bin Fu et al2011,"The research about the treatment efficacy in the treatment of elderly patients with hypertension between bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc), the WMD of the data of the systolic blood pressure is too big:-8.70[-12.16,-5.24], so we give it excluded, the remaining3trials which include a total of318patients, show the heterogeneity (χ2=0.07, P=0.97, I2=0%).So the fixed effects model meta-analysis is used.And there is also no significant difference between bisoprolol fumarate (Kang Xin) and metoprolol tartrate (Betaloc) in lowering systolic blood pressure:WMD (95%CI):0.16-2.02,2.33], P=0.89.Conclusion:Compared with metoprolol tartrate (Betaloc),bisoprolol fumarate (Kang Xin) shows a higher efficiency in controlling blood pressure, but There are no significant differences in lowering systolic blood pressure, diastolic blood pressure, heart rate, and the rate of the incidence of adverse reactions between the two drugs. |
