Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis.
Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis.
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DOI：
10.1136/bmj.e4260
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发表时间：
2012-07-11
期刊：
影响因子：
--
通讯作者：
Costa J
中科院分区：
文献类型：
--
作者：
Caldeira D;Alarcão J;Vaz-Carneiro A;Costa J
目的系统评价血管紧张素转换酶(ACE)抑制剂或血管紧张素受体阻滞剂(ARB)的使用与肺炎风险的纵向研究。设计系统回顾和荟萃分析。数据来源：Medline通过PubMed、Web of Science和会议记录(始于2011年6月)和美国食品和药物管理局网站(2011年6月)。对检索到的文章进行系统综述和参考文献检索。研究选择两位评价者独立选择的随机对照试验和队列及病例对照研究，评估血管紧张素转换酶抑制剂或ARB的使用和肺炎的风险，并检索这些研究的特征和数据估计。资料综合：主要结果是肺炎发生率，次要结果是肺炎相关死亡率。根据基线发病率(中风、心力衰竭和慢性肾脏疾病)和患者的特征(亚洲人和非亚洲人)进行亚组分析。通过随机效应荟萃分析得出合并估计的优势比和95%可信区间。调整后的频率间接比较血管紧张素转换酶抑制剂和ARB被估计，并结合直接证据，只要有。异质性用I2检验进行评估。结果纳入37篇符合条件的研究。与对照治疗(19项研究：优势比0.66，95%可信区间0.55至0.80；I2=79%)和ARBS(合并直接和间接优势比估计值0.69，0.56至0.85)相比，血管紧张素转换酶抑制剂显著降低肺炎风险。在中风患者中，与对照组(优势比0.46，0.34比0.62)和ARBS(0.42，0.22比0.80)相比，接受ACE抑制剂治疗的患者患肺炎的风险也更低。与非亚洲患者(0.82，0.67，1.00；P<；0.001)相比，亚洲患者患肺炎的风险显著降低(0.43，0.34至0.54)。与对照治疗相比，ACE抑制剂(7项研究：优势比0.73，0.58比0.92；I2=51%)和ARBS(一项随机对照试验：0.63，0.40比1.00)都与肺炎相关死亡率的降低有关，干预措施之间没有差异。结论：现有最好的证据表明，ACE抑制剂在肺炎风险中可能起到保护作用，而不是ARB。可能受益最大的患者群体是既往中风患者和亚洲患者。ACE抑制剂也与肺炎相关死亡率的降低有关，但数据缺乏说服力。
Objective To systematically review longitudinal studies evaluating use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and risk of pneumonia. Design Systematic review and meta-analysis. Data sources Medline through PubMed, Web of Science with conference proceedings (inception to June 2011), and US Food and Drug Administration website (June 2011). Systematic reviews and references of retrieved articles were also searched. Study selection Two reviewers independently selected randomised controlled trials and cohort and case-control studies evaluating the use of ACE inhibitors or ARBs and risk of pneumonia and retrieved characteristics of the studies and data estimates. Data synthesis The primary outcome was incidence of pneumonia and the secondary outcome was pneumonia related mortality. Subgroup analyses were carried according to baseline morbidities (stroke, heart failure, and chronic kidney disease) and patients’ characteristics (Asian and non-Asian). Pooled estimates of odds ratios and 95% confidence intervals were derived by random effects meta-analysis. Adjusted frequentist indirect comparisons between ACE inhibitors and ARBs were estimated and combined with direct evidence whenever available. Heterogeneity was assessed using the I2 test. Results 37 eligible studies were included. ACE inhibitors were associated with a significantly reduced risk of pneumonia compared with control treatment (19 studies: odds ratio 0.66, 95% confidence interval 0.55 to 0.80; I2=79%) and ARBs (combined direct and indirect odds ratio estimate 0.69, 0.56 to 0.85). In patients with stroke, the risk of pneumonia was also lower in those treated with ACE inhibitors compared with control treatment (odds ratio 0.46, 0.34 to 0.62) and ARBs (0.42, 0.22 to 0.80). ACE inhibitors were associated with a significantly reduced risk of pneumonia among Asian patients (0.43, 0.34 to 0.54) compared with non-Asian patients (0.82, 0.67 to 1.00; P<0.001). Compared with control treatments, both ACE inhibitors (seven studies: odds ratio 0.73, 0.58 to 0.92; I2=51%) and ARBs (one randomised controlled trial: 0.63, 0.40 to 1.00) were associated with a decrease in pneumonia related mortality, without differences between interventions. Conclusions The best evidence available points towards a putative protective role of ACE inhibitors but not ARBs in risk of pneumonia. Patient populations that may benefit most are those with previous stroke and Asian patients. ACE inhibitors were also associated with a decrease in pneumonia related mortality, but the data lacked strength.
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DOI：
10.1016/s0140-6736(03)15021-0
发表时间：
2003-12-13
期刊：
Lancet (London, England)
影响因子：
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DOI：
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期刊：
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10.1111/j.1532-5415.2004.52556.x
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影响因子：
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