Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 12. Antihypertensive Medicin_Chinese Journal of Evidence-Based Medicine

Authors：

Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

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Keywords：

Township health center; Essential medicine; Evidence-based evaluation and selection; Antihypertensive medicine

DOI：

10.7507/1672-2531.20120151

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Objective To evaluate and select essential antihypertensive medicine using evidence-based approaches based on the burden of disease for township health centers located in eastern, central and western regions of China.
Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.
Results (1) Five clinical guidelines on hypertension were included, two of which were evidence-based. (2) Totally there were nine classes and 70 antihypertensive medicines listed in the guidelines. (3) According to WHOEML (2011), NEML (2009), CNF (2010), other guidelines, and the quantity and quality of evidence, we offered a b recommendation for nifedipine, verapamil and enalapril and a weak recommendation for hydrochlorothiazide, indapamide, spironolactone, propranolol, metoprolol and amlodipine. We made a recommendation against furosemide and timolol due to the lack of evidence from guidelines. (4) Nine recommended medicines have been marketed with the dosage forms and specifications corresponding to guidelines in China. The prices of metoprolol, amlodipine and enalapril were higher than those of other six (daily cost: metoprolol 3.80 to 7.60 yuan, amlodipine 2.16 to 4.32 yuan, and enalapril 0.86 to 6.88 yuan). As a whole, the prices of recommended antihypertensive medicine were affordable. (5) Results of domestic studies indicated that three bly-recommended medicines (including nifedipine, verapamil and enalapril) were safe, effective, economical and applicable.
Conclusion (1) We offer a b recommendation for nifedipine, verapamil and enalapril as antihypertensive medicine and a weak recommendation for hydrochlorothiazide, indapamide, spironolactone, propranolol, metoprolol and amlodipine. (2) There is lack of high-quality evidence from relevant domestic studies, especially on long-term safety and pharmacoeconomic evidence. (3) We propose that more studies should be carried out on the safety, efficacy and pharmacoeconomics of six medicines for which we make a weak recommendation to produce high-quality local evidence.

Citation： SHEN Jiantong,YANG Xiaoyan,LI Youping,WANG Li,LI Xiao,LI Honghao,LI Cuicui,WANG Yingqiang,LI Xianglian,YANG Zongxia. Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 12. Antihypertensive Medicin. Chinese Journal of Evidence-Based Medicine, 2012, 12(8): 958-966. doi: 10.7507/1672-2531.20120151 Copy

1.	刘力生. 2009年高血压防治新进展学术报告会讲话. Available from: http://www.cnr.cn.
2.	NICE, The clinical management of primary hypertension in adults. 2011. Available from: http://www.nice.org.uk.
3.	Patricia Mk, Megan W, Kristi R, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365: 217-223.
4.	国家心血管病中心, 高血压联盟(中国). 中国高血压防治指南2010. 中国高血压杂志, 2011, 19(8) : 701-743.
5.	李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选中国东中西部乡院基本药物系列之二：评价标准、方法与流程研究. 中国循证医学杂志, 2012, 12(3): 347-356.
6.	国家发展改革委.《国家发展改革委关于公布国家基本药物零售指导价格的通知》. 2009.
7.	胡大一, 王宏宇. 高血压病流行的全球趋势及对策.中国实用内科杂志, 2002, 22(4): 193-195.
8.	CHEP. The 2011 Canadian Hypertension Education Program Recommendations for the Management of Hypertension: Blood Pressure Measurement, Diagnosis, Assessment of Risk, and Therapy. Canadian Journal of Cardiology, 2011, 27(4): 415-433.
9.	NHLBI. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 2004. Available from: http://www.nhlbi.nih.gov.
10.	SAHS. South African Hypertension Guideline. South African Medical Journal, 2012, 102(1): 57-84.
11.	Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med, 2008, 359: 2417-2428.
12.	Messerli FH, Makani H, Benjo A, et al. Antihypertensive efficacy of hydrochlorothiazide as evaluated by ambulatory blood pressure monitoring: a meta-analysis of randomized trials. Journal of the American College of Cardiology, 2011, 57(5): 590-600.
13.	徐标, 金振刚, 任国亮, 等. 返璞能否归真——论利尿剂在抗高血压治疗中的地位. 中华高血压杂志, 2010, 18(3): 203-207.
14.	Mancia G, Laurent S, Agabiti RE, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task. Journal of Hypertension, 2009, 27(11): 2121-2158.
15.	刘淑涛, 王慧玲. 硝苯地平和氨氯地平治疗高血压疗效与安全性的Meta分析. 中国药房, 2011, 22(16): 1494-1497.
16.	李延鸿, 朱怀军. 硝苯地平舌下含服治疗高血压病Meta分析. 中国药物与临床, 2009, 9(2): 131-132.
17.	成都高血压干预试验协作组. 高血压干预试验: 硝苯地平与安慰剂随机对照研究. 中华心血管病杂志, 1994, 22(3): 201-205.
18.	上海市老年人高血压治疗干预试验协作组. 硝苯啶治疗老年高血压预防并发症的前瞻性研究.中华心血管病杂志, 1992, 20(5): 281-284.
19.	刘景艳, 刘景芳, 王思箭. 三种钙离子拮抗剂治疗144例原发性高压成本－效果分析. 中国临床医药研究杂志, 2004, (118): 12450-12451.
20.	陈平. 硝苯地平、非洛地平、氨氯地平治疗高血压成本-效果分析. 当代医学(学术版), 2008, (3): 161.
21.	冯璇, 童冬梅, 徐翔. 三种钙通道阻滞剂治疗高血压的费用-效果分析. 中国临床药理学与治疗学, 2001, 6(3): 232-233.
22.	焦章群. 3种常用降压药物的成本－效果比较. 中国医院药学杂志, 2007, 27(9): 1294-1295.
23.	王定营, 杨巍. 3种医保药物治疗高血压的成本－效果分析. 右江民族医学院学报, 2008, 30(2): 278-279.
24.	董碧蓉, 曹立亚, 周焱, 等. 8种血管紧张素转换酶抑制剂治疗高血压的临床疗效、安全性及成本-效果评估. 中国循证医学杂志, 2004, 4(1): 15-28.
25.	杜亚明, 胡燕. 厄贝沙坦与依那普利治疗轻中度原发性高血压疗效与安全性比较的Meta分析. 中国药房, 2010, (32): 3053-3056.
26.	万里燕, 崔建, 周新, 等. 氯沙坦与依那普利治疗原发性高血压的Meta分析. 药物流行病学杂志, 2007, 16(1): 19-22.
27.	袁浩荣, 洪晓霞. 依那普利治疗原发性高血压病128例疗效观察. 河北中西医结合杂志, 1995, 4(4): 6-7.
28.	向红菊, 刘华玉. 2种给药方案治疗高血压的成本-效果分析. 中国卫生产业, 2011, 8(3): 61.
29.	邓莉娜, 张玉港. 3种药物治疗原发性高血压的成本－效果分析. 中国药房, 2007, 18(32): 2489-2490.
30.	梁震野, 嵇宏亮. 厄贝沙坦和依那普利治疗轻中度高血压的费用－效果分析. 海峡药学, 2007, 19(5): 87-88.
31.	李刚, 王小丽, 周宏. 3种转换酶抑制剂治疗原发性高血压的成本－效果分析. 中国医院用药评价与分析, 2002, 2(4): 215-216.
32.	宁洁, 李冬生. 4种高血压治疗方案的药物经济学分析. 天津药学, 2007, 19(3): 48-50.
33.	周冀平. 原发性高血压患者3种治疗方案近期临床效益比较分析. 中国药师, 2006, 9(9): 866-867.
34.	陈义森, 李佳莉. 舌下含异搏定的急性降压作用. 中华心血管病杂志, 1989, 17(1): 35-36.
35.	邵耕, 李琳, 张树彬, 等. 缓释异搏停治疗高血压疗效初步报告. 北京医科大学学报, 1989, 21(6): 467-471.
36.	及新, 朱维忠, 李元红, 等. 异搏定治疗高血压近期疗效观察. 恩施医专学报, 1989, 6(1): 26-28.
37.	诸骏仁, 王敬良, 陶萍, 等. 非洛地平缓释片与维拉帕米缓释片降压疗效比较. 中华心血管病杂志, 1996, 24(5): 366-369.
38.	于学海, 张树和, 陈桂英. 缓释维拉帕米、地尔硫及硝苯啶对高血压患者疗效的比较. 实用心脑肺血管病杂志, 1996, 4(3): 30-32.
39.	Amery A, Birkenhäger W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet, 1985, 1(8442): 1349-1354.
40.	Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet, 1990, 335(8693): 827-838.
41.	Sareli P, Radevski IV, Valtchanova ZP, et al. Efficacy of different drug classes used to initiate antihypertensive treatment in black subjects: results of a randomized trial in Johannesburg, South Africa. Arch Intern Med, 2001, 161(7): 965-971.
42.	Rosei EA, Dal Palù C, Leonetti G, et al. Clinical results of the Verapamil in Hypertension and Atherosclerosis Study. VHAS Investigators. J Hypertens, 1997, 15(11): 1337-1344.

1. 刘力生. 2009年高血压防治新进展学术报告会讲话. Available from: http://www.cnr.cn.
2. NICE, The clinical management of primary hypertension in adults. 2011. Available from: http://www.nice.org.uk.
3. Patricia Mk, Megan W, Kristi R, et al. Global burden of hypertension: analysis of worldwide data. Lancet, 2005, 365: 217-223.
4. 国家心血管病中心, 高血压联盟(中国). 中国高血压防治指南2010. 中国高血压杂志, 2011, 19(8) : 701-743.
5. 李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选中国东中西部乡院基本药物系列之二：评价标准、方法与流程研究. 中国循证医学杂志, 2012, 12(3): 347-356.
6. 国家发展改革委.《国家发展改革委关于公布国家基本药物零售指导价格的通知》. 2009.
7. 胡大一, 王宏宇. 高血压病流行的全球趋势及对策.中国实用内科杂志, 2002, 22(4): 193-195.
8. CHEP. The 2011 Canadian Hypertension Education Program Recommendations for the Management of Hypertension: Blood Pressure Measurement, Diagnosis, Assessment of Risk, and Therapy. Canadian Journal of Cardiology, 2011, 27(4): 415-433.
9. NHLBI. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). 2004. Available from: http://www.nhlbi.nih.gov.
10. SAHS. South African Hypertension Guideline. South African Medical Journal, 2012, 102(1): 57-84.
11. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med, 2008, 359: 2417-2428.
12. Messerli FH, Makani H, Benjo A, et al. Antihypertensive efficacy of hydrochlorothiazide as evaluated by ambulatory blood pressure monitoring: a meta-analysis of randomized trials. Journal of the American College of Cardiology, 2011, 57(5): 590-600.
13. 徐标, 金振刚, 任国亮, 等. 返璞能否归真——论利尿剂在抗高血压治疗中的地位. 中华高血压杂志, 2010, 18(3): 203-207.
14. Mancia G, Laurent S, Agabiti RE, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task. Journal of Hypertension, 2009, 27(11): 2121-2158.
15. 刘淑涛, 王慧玲. 硝苯地平和氨氯地平治疗高血压疗效与安全性的Meta分析. 中国药房, 2011, 22(16): 1494-1497.
16. 李延鸿, 朱怀军. 硝苯地平舌下含服治疗高血压病Meta分析. 中国药物与临床, 2009, 9(2): 131-132.
17. 成都高血压干预试验协作组. 高血压干预试验: 硝苯地平与安慰剂随机对照研究. 中华心血管病杂志, 1994, 22(3): 201-205.
18. 上海市老年人高血压治疗干预试验协作组. 硝苯啶治疗老年高血压预防并发症的前瞻性研究.中华心血管病杂志, 1992, 20(5): 281-284.
19. 刘景艳, 刘景芳, 王思箭. 三种钙离子拮抗剂治疗144例原发性高压成本－效果分析. 中国临床医药研究杂志, 2004, (118): 12450-12451.
20. 陈平. 硝苯地平、非洛地平、氨氯地平治疗高血压成本-效果分析. 当代医学(学术版), 2008, (3): 161.
21. 冯璇, 童冬梅, 徐翔. 三种钙通道阻滞剂治疗高血压的费用-效果分析. 中国临床药理学与治疗学, 2001, 6(3): 232-233.
22. 焦章群. 3种常用降压药物的成本－效果比较. 中国医院药学杂志, 2007, 27(9): 1294-1295.
23. 王定营, 杨巍. 3种医保药物治疗高血压的成本－效果分析. 右江民族医学院学报, 2008, 30(2): 278-279.
24. 董碧蓉, 曹立亚, 周焱, 等. 8种血管紧张素转换酶抑制剂治疗高血压的临床疗效、安全性及成本-效果评估. 中国循证医学杂志, 2004, 4(1): 15-28.
25. 杜亚明, 胡燕. 厄贝沙坦与依那普利治疗轻中度原发性高血压疗效与安全性比较的Meta分析. 中国药房, 2010, (32): 3053-3056.
26. 万里燕, 崔建, 周新, 等. 氯沙坦与依那普利治疗原发性高血压的Meta分析. 药物流行病学杂志, 2007, 16(1): 19-22.
27. 袁浩荣, 洪晓霞. 依那普利治疗原发性高血压病128例疗效观察. 河北中西医结合杂志, 1995, 4(4): 6-7.
28. 向红菊, 刘华玉. 2种给药方案治疗高血压的成本-效果分析. 中国卫生产业, 2011, 8(3): 61.
29. 邓莉娜, 张玉港. 3种药物治疗原发性高血压的成本－效果分析. 中国药房, 2007, 18(32): 2489-2490.
30. 梁震野, 嵇宏亮. 厄贝沙坦和依那普利治疗轻中度高血压的费用－效果分析. 海峡药学, 2007, 19(5): 87-88.
31. 李刚, 王小丽, 周宏. 3种转换酶抑制剂治疗原发性高血压的成本－效果分析. 中国医院用药评价与分析, 2002, 2(4): 215-216.
32. 宁洁, 李冬生. 4种高血压治疗方案的药物经济学分析. 天津药学, 2007, 19(3): 48-50.
33. 周冀平. 原发性高血压患者3种治疗方案近期临床效益比较分析. 中国药师, 2006, 9(9): 866-867.
34. 陈义森, 李佳莉. 舌下含异搏定的急性降压作用. 中华心血管病杂志, 1989, 17(1): 35-36.
35. 邵耕, 李琳, 张树彬, 等. 缓释异搏停治疗高血压疗效初步报告. 北京医科大学学报, 1989, 21(6): 467-471.
36. 及新, 朱维忠, 李元红, 等. 异搏定治疗高血压近期疗效观察. 恩施医专学报, 1989, 6(1): 26-28.
37. 诸骏仁, 王敬良, 陶萍, 等. 非洛地平缓释片与维拉帕米缓释片降压疗效比较. 中华心血管病杂志, 1996, 24(5): 366-369.
38. 于学海, 张树和, 陈桂英. 缓释维拉帕米、地尔硫及硝苯啶对高血压患者疗效的比较. 实用心脑肺血管病杂志, 1996, 4(3): 30-32.
39. Amery A, Birkenhäger W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet, 1985, 1(8442): 1349-1354.
40. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet, 1990, 335(8693): 827-838.
41. Sareli P, Radevski IV, Valtchanova ZP, et al. Efficacy of different drug classes used to initiate antihypertensive treatment in black subjects: results of a randomized trial in Johannesburg, South Africa. Arch Intern Med, 2001, 161(7): 965-971.
42. Rosei EA, Dal Palù C, Leonetti G, et al. Clinical results of the Verapamil in Hypertension and Atherosclerosis Study. VHAS Investigators. J Hypertens, 1997, 15(11): 1337-1344.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 12. Antihypertensive Medicin

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