New Users of Angiotensin II Receptor Blocker-Versus Angiotensin-Converting Enzyme Inhibitor-Based Antihypertensive Medication Regimens and Cardiovascular Disease Events: A Secondary Analysis of ACCORD-BP and SPRINT.
New Users of Angiotensin II Receptor Blocker-Versus Angiotensin-Converting Enzyme Inhibitor-Based Antihypertensive Medication Regimens and Cardiovascular Disease Events: A Secondary Analysis of ACCORD-BP and SPRINT.
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DOI：
10.1161/jaha.123.030311
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发表时间：
2023-09-05
影响因子：
5.4
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中科院分区：
文献类型：
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血管紧张素II受体阻滞剂（ARB）和血管紧张素转换酶抑制剂（ACEI）阻断肾素-血管紧张素系统的不同组分。这是否转化为对心血管疾病事件的不同影响尚不清楚。我们使用雅阁‐BP（控制糖尿病心血管风险的措施-血压）试验和SPRINT（收缩压干预试验）来模拟ARB与ACEI新使用者在心血管疾病事件（主要结局）和死亡（次要结局）方面的目标试验。我们用治疗权重的逆概率估计了边际病因特异性风险比（HR）和治疗特异性累积发生率函数。我们确定了3298例ARB或ACEI新使用者（雅阁‐BP：374例ARB vs 884例ACEI; SPRINT：727例ARB vs 1313例ACEI）。对于开始ARB与ACEIs的受试者，雅阁-BP中主要结局的治疗体重率的逆概率为3.2 vs 3.5/100人年（HR，0.91 [95% CI，0.63-1.31]），SPRINT中为1.8 vs 2.2/100人年（HR，0.81 [95% CI，0.56-1.18]）。汇总分析中没有明显差异，除了ARB与ACEIs相比死亡率较低（HR，0.56 [95% CI，0.37-0.85]）。在男性与女性受试者、非西班牙裔黑人与非西班牙裔白色受试者以及随机分配到标准血压组与强化血压组的受试者亚组中，ARB与主要结局发生率较低相关（P相互作用：分别为<0.01、0.05和<0.01）。在雅阁‐BP和SPRINT的次要分析中，ARB与ACEI降压药物方案的新使用者发生心血管疾病事件的发生率相似，具有重要的亚组差异，总体死亡率较低。URL：https://www.clinicaltrials.gov;唯一标识符：NCT 01206062、NCT 00000620。
Angiotensin II receptor blockers (ARBs) and angiotensin‐converting enzyme inhibitors (ACEIs) block distinct components of the renin‐angiotensin system. Whether this translates into differential effects on cardiovascular disease events remains unclear. We used the ACCORD‐BP (Action to Control Cardiovascular Risk in Diabetes–Blood Pressure) trial and the SPRINT (Systolic Blood Pressure Intervention Trial) to emulate target trials of new users of ARBs versus ACEIs on cardiovascular disease events (primary outcome) and death (secondary outcome). We estimated marginal cause‐specific hazard ratios (HRs) and treatment‐specific cumulative incidence functions with inverse probability of treatment weights. We identified 3298 new users of ARBs or ACEIs (ACCORD‐BP: 374 ARB versus 884 ACEI; SPRINT: 727 ARB versus 1313 ACEI). For participants initiating ARBs versus ACEIs, the inverse probability of treatment weight rate of the primary outcome was 3.2 versus 3.5 per 100 person‐years in ACCORD‐BP (HR, 0.91 [95% CI, 0.63–1.31]) and 1.8 versus 2.2 per 100 person‐years in SPRINT (HR, 0.81 [95% CI, 0.56–1.18]). There were no appreciable differences in pooled analyses, except that ARBs versus ACEIs were associated with a lower death rate (HR, 0.56 [95% CI, 0.37–0.85]). ARBs were associated with a lower rate of the primary outcome among subgroups of male versus female participants, non‐Hispanic Black versus non‐Hispanic White participants, and those randomly assigned to standard versus intensive blood pressure (P interaction: <0.01, 0.05, and <0.01, respectively). In this secondary analysis of ACCORD‐BP and SPRINT, new users of ARB‐ versus ACEI‐based antihypertensive medication regimens experienced similar cardiovascular disease events rates, with important subgroup differences and lower rates of death overall. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01206062, NCT00000620.
执行轻度认知障碍中的降压治疗和脑血流动力学：试点随机临床试验的结果。
影响因子：
6.3
作者：
Hajjar I;Hart M;Chen YL;Mack W;Novak V;C Chui H;Lipsitz L
通讯作者：
Lipsitz L