| Background: Hypertension is the leading hazard of cardia-cerebrovascular diseases,and also the main cause of death of cardia-cerebrovascular diseases.It has been found domestically and internationally that hypertension is a kind of chronic disease that can be prevented and controlled,and that lowering the blood pressure level of the hypertension patients,especially the control of hypertension level of the mid-aged or the senior-aged patients,may reduce the occurrence of cerebro apoplexy and heart diseases and improve the living quality of the patients.Non-medicine treating is the basic methods to control hypertension,however,as a crucial measure of treating hypertension,medicine intervention is a kind of indispensable and important treatment measure.For a long period,β-blockers all have been used as the first-line medicines to treat hypertension,and since 1960 s,these have been used for clinical treatment for more than 50 years.However,in recent 20 years,as the medicines to treat hypertension,β-blockers have aroused a lot of controversies.In recent published random contrast experiments and guides to hypertension,researchers suggested thatβ-blockers should not be supported as the first-line medicine to treat the aged hypertension,furthermore,in some hypertension guides,β-blockers have not been recommended to treat aged patients of hypertension.This paper designed such assembly analyses of massive random contrast experiment results published in recent years to further elaborate the safety and effectiveness of the application of β-blockers to treat the aged patients of hypertension..Objective:To compare the main adverse incident occurrence rate of the treatment of the aged hypertension when β-blockers and other hypotensors or placebos,and then make assembly analyses of these,meanwhile,through contrasting the antihypertensive effects of other hypotensors,the researchers will discuss the safety and efficacy of the application of β-blockers to treat hypertension compared to other medicines.Methods: The research was done through searching databases of Pub Med(1985-2017),EMBASE(1985-2017),China periodicals(1995-2017),Wanfang(1980-2017);meanwhile,manually and comprehensively search some relevant literature and journals,free charged literature mutual platforms,guides and references,and other means for relevant literature.Searching methods were as follows: made retrievals on{β-blockers OR atenolol OR bisoprolol OR metoprolol} and hypertension and{cardiovascular events or cardiovascular risk or total mortality or stroke},and screen treatment group for using β-blockers as hypotensor intervention strictly based on the intaking and excluding standard,the intervened group was the senior-aged people more than 60 years old,and the control group was a random control experiment by using placebos or other first-line hypotensors(ACEI,ARB,CCB,and diuretics).One evaluator is responsible to independently extract the literature,and make quality analysis and evaluation on the literature according to the risk bias evaluation tool,Cochrane,recommended in the Cochrane Handbook 5.1.0.Using JADE scale to grade and screen the random control experiments,finally,using Rev Man5.3 to make assembly analyses of each effective dose,draw a forest map,and interpret the results.Compare β-blockers with other hypotensors or placebo group to learn the influence of occurrence rates of major adverse incidents(including mortality,apoplexy,and adverse cardiovascular incidents),antihypertensive efficacy and all-cause mortality incidents,apoplexy incidents,and adverse cardiovascular incidents.Results:17 standard-compliant random control experiments were included,and all these 17 literature were random contrast experiments by taking β-blockers as experimental groups while taking other hypotensors or placebo as control groups,which can be classified into three contrast groups in details,namely,the group of adverse incidents in contrast with β-blockers and placebo,the group of adverse incidents in contrast with β-blockers and other hypotensors,and the curative effect group in contrast withβ-blockers and other hypotensors.The group of adverse incidents in contrast with β-blockers and placebo: The main results of this group were included in 6 pieces of literature,which were respectively classified into β-blockers group n=3495,and placebo group n=4645;in contrast with the major adverse incidents(including mortality,apoplexy,and adverse cardiovascular incidents)occurring between β-blockers and placebos,and results showed that there were no significant differences of the occurrence rate of the aged major adverse incidents between β-blockers and the control group,(OR=0.90,95% CI: [0.79,1.02,P=0.10).In Subgroup Ⅰ,the results were included in 4 pieces of literature for independent contrast,which were respectively classified into β-blockers group n=3018,the placebo group n=4107;in contrast with the apoplexy incidents occurring between β-blockers and placebos,the results showed that there were no significant differences of the occurrence rate of the aged secondary adverse incidents between β-blockers and the control group,(OR=0.88,95% CI: [0.60,1.28,P=0.49).In Subgroup Ⅱ,the results were included in 4 pieces of literature for independent contrast,which were respectively classified into β-blockers group n=3018,and placebo group n=4107;in contrast with the adverse cardiovascular incidents occurring between β-blockers and placebos,the results showed that there were no significant differences of the occurrence rate of the aged adverse cardiovascular incidents between β-blockers and the control group,(OR=0.91,95% CI: [0.74,1.11,P=0.33).In Subgroup Ⅲ,the results were included in 4 pieces of literature for independent contrast,which were respectively classified into β-blockers group n=3018,and placebo group n=4107;in contrast with the mortality incidents occurring between β-blockers and placebos,the results showed that there were no significant differences of the occurrence rate of the aged mortality incidents between β-blockers and the control group,(OR=0.99,95%CI: [0.83,1.17,P=0.89).The group of adverse incidents in contrast with β-blockers and other hypotensors: The main results of this group were included in 9 pieces of literature,which were respectively classified into β-blockers group n=44005,and other hypotensor group n=43914;in contrast with the major adverse incidents(including mortality,apoplexy,and adverse cardiovascular incidents)occurring between β-blockers and other hypotensors,the results showed that the risk increased by 7% when occurrence rates of the aged major adverse incidents between β-blockers and the control group were contrasted,(OR=1.07,95% CI: [1.02,1.11,P=0.006),and the differences were of statistical significance.In Subgroup Ⅰ,the results were included in 5 pieces of literature,which were respectively classified into β-blockers group n=22694,and other hypotensors,group n=22626;in contrast with the major adverse incidents(apoplexy)occurring between β-blockers and other hypotensors,the risk of occurrence rates increased by 21%(OR=1.21,95% CI: [1.09,1.35,P=0.0004),the differences were of statistical significance.In Subgroup Ⅱ,the results were included in 5 pieces of literature,which were respectively classified into β-blockers group n=22694,and other hypotensor group n=22626;in contrast with the secondary adverse incidents(cardiovascular incidents)occurring between β-blockers and other hypotensors,there were no statistical significance about occurrence rates(OR=1.07,95% CI: [0.96,1.19,P=0.24).In Subgroup Ⅲ,the results were included in 5 pieces of literature,which were respectively classified into β-blockers group n=22694,and other hypotensor group n=22626;in contrast with the secondary adverse incidents(mortality incidents)occurring between β-blockers and other hypotensors,there were no statistical significance about occurrence rates(OR=1.07,95% CI: [0.96,1.19,P=0.25).The curative effect group in contrast with β-blockers and other hypotensors:The results were included in 5 pieces of literature,which were respectively classified into β-blockers group n=916,and other hypotensor group n=929;in contrast with the average difference of systolic pressures(MD=-0.59,95%CI: [-1.75,0.58],P=0.32)before and after depressurization occurring between β-blockers and other hypotensors,there were no statistical significance about the differences.Meanwhile,the patients were respectively classified into β-blockers group n=916,and other hypotensor group n=929;in contrast with the average differences of diastolic pressures(MD=0.73,95% CI: [-0.29,1.74],P=0.16)before and after depressurization occurring between β-blockers and other hypotensors,there are no statistical significance about the differences.Conclusion:Beta blockers as initial medication over the age of 60 elderly patients with hypertension,the antihypertensive effect is comparable to that of other antihypertensive agents,but may increase adverse events(such as stroke,cardiovascular accident,the incidence of death). |
PDF Full Text Request