Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials.
Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials.
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DOI：
10.1136/bmj.f5680
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发表时间：
2013-10-03
期刊：
影响因子：
--
通讯作者：
MacMahon S
中科院分区：
文献类型：
--
作者：
Blood Pressure Lowering Treatment Trialists' Collaboration;Ninomiya T;Perkovic V;Turnbull F;Neal B;Barzi F;Cass A;Baigent C;Chalmers J;Li N;Woodward M;MacMahon S
目的明确慢性肾脏病患者降压治疗的心血管效应。设计随机试验的协作前瞻性荟萃分析。资料来源和入选资格参与的降压药物与安慰剂或相互比较或比较不同血压目标的随机试验，每组至少随访1000患者年。主要结局指标主要心血管事件（卒中、心肌梗死、心力衰竭或心血管死亡）的复合和个体以及全因死亡。参与者26项试验（152 290名参与者），包括30 295名估计肾小球滤过率（eGFR）降低的个体，其定义为eGFR <60 mL/min/1.73m2。数据提取23项试验的个体受试者数据可用，另外3项试验的汇总数据可用。根据基线肾功能进行荟萃分析。采用随机效应模型估计血压每降低5 mm Hg的合并风险比。结果：与安慰剂相比，降压方案可使收缩压每降低5 mm Hg，主要心血管事件的风险降低约六分之一。（风险比0.83，95%置信区间0.76 - 0.90）且eGFR未降低（0.83，0.79至0.88），没有证据表明效果存在任何差异（同质性P=1.00）。无论基于血管紧张素转换酶抑制剂、钙拮抗剂或利尿剂/β受体阻滞剂的治疗方案是否降低血压，结果均相似。没有证据表明不同药物类别对主要心血管事件的影响在不同eGFR的患者之间存在差异（同质性均P>0.60）。结论在eGFR中度降低的人群中，降低血压是预防心血管事件的有效策略。这些综述中几乎没有证据支持优先选择特定药物类别预防慢性肾脏疾病的心血管事件。
Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease. Design Collaborative prospective meta-analysis of randomised trials. Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or each other or that compare different blood pressure targets, with at least 1000 patient years of follow-up per arm. Main outcome measures Major cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death) in composite and individually and all cause death. Participants 26 trials (152 290 participants), including 30 295 individuals with reduced estimated glomerular filtration rate (eGFR), which was defined as eGFR <60 mL/min/1.73m2. Data extraction Individual participant data were available for 23 trials, with summary data from another three. Meta-analysis according to baseline kidney function was performed. Pooled hazard ratios per 5 mm Hg lower blood pressure were estimated with a random effects model. Results Compared with placebo, blood pressure lowering regimens reduced the risk of major cardiovascular events by about a sixth per 5 mm Hg reduction in systolic blood pressure in individuals with (hazard ratio 0.83, 95% confidence interval 0.76 to 0.90) and without reduced eGFR (0.83, 0.79 to 0.88), with no evidence for any difference in effect (P=1.00 for homogeneity). The results were similar irrespective of whether blood pressure was reduced by regimens based on angiotensin converting enzyme inhibitors, calcium antagonists, or diuretics/β blockers. There was no evidence that the effects of different drug classes on major cardiovascular events varied between patients with different eGFR (all P>0.60 for homogeneity). Conclusions Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease.
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影响因子：
168.9
作者：
Heerspink, HiddoJ Lambers;Ninomiya, Toshiharu;Zoungas, Sophia;de Zeeuw, Dick;Grobbee, Diederick E.;Jardine, Meg J.;Gallagher, Martin;Roberts, Matthew A.;Cass, Alan;Neal, Bruce;Perkovic, Vlado
通讯作者：
Perkovic, Vlado
DOI：
10.1056/nejmoa0910975
发表时间：
2010-09-02
期刊：
The New England journal of medicine
影响因子：
--
作者：
Appel LJ;Wright JT Jr;Greene T;Agodoa LY;Astor BC;Bakris GL;Cleveland WH;Charleston J;Contreras G;Faulkner ML;Gabbai FB;Gassman JJ;Hebert LA;Jamerson KA;Kopple JD;Kusek JW;Lash JP;Lea JP;Lewis JB;Lipkowitz MS;Massry SG;Miller ER;Norris K;Phillips RA;Pogue VA;Randall OS;Rostand SG;Smogorzewski MJ;Toto RD;Wang X;AASK Collaborative Research Group
通讯作者：
AASK Collaborative Research Group
影响因子：
1.9
作者：
Duval, S;Tweedie, R
通讯作者：
Tweedie, R
影响因子：
168.9
作者：
Hansson, L;Lindholm, LH;Björck, JE
通讯作者：
Björck, JE
影响因子：
168.9
作者：
Hansson, L;Zanchetti, A;Westerling, S
通讯作者：
Westerling, S