Hypertension mega-trials with cardiovascular end points: Effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
Hypertension mega-trials with cardiovascular end points: Effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
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DOI：
10.1016/j.ahj.2004.04.037
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发表时间：
2004-11-01
影响因子：
4.8
通讯作者：
Julius, S
中科院分区：
文献类型：
--
作者：
Kjeldsen, SE;Julius, S
背景：肾素-血管紧张素-醛固酮系统通过其主要介质血管紧张素II在血压的短期和长期调节中起关键作用。血管紧张素转换酶（ACE）抑制剂和血管紧张素II受体阻滞剂（ARB）可降低血管紧张素II对血管和心脏的有害作用，但作用机制不同。虽然ACE抑制剂和ARB的降压作用与大多数其他降压药相当，但新出现的数据表明，这些药物类别可能对降低心血管发病率具有更大的作用，特定患者人群的死亡率。（约大于或等于5000例患者）使用ACE抑制剂和ARB的高血压临床试验和心血管发病率/结果选择了6项ACE抑制剂试验和5项ARB试验（3项已完成，2项正在进行）进行分析。这些高血压大型试验的数据表明，ACE抑制剂和ARB可能降低心血管发病率和死亡率，尤其是在糖尿病、肾功能不全和左心室肥大患者中。然而，一些试验表明，重要的血压差异，因此部分是不确定的特定药物effects.Conclusions最近报道和正在进行的大型试验的肾素-血管紧张素-醛固酮系统抑制剂的分析可能支持的概念，其血管保护性能赋予更大的好处凭借其效果超越血压降低。未来几年将完成的试验结果可能会进一步支持阻断肾素-血管紧张素系统在高血压治疗中的心血管保护作用。
Background The renin-angiotensin-aldosterone system has a pivotal role in the short- and long-term regulation of blood pressure through its principal mediator, angiotensin II. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II-receptor blockers (ARBs) decrease the deleterious effects of angiotensin II on the vasculature and heart, but have different mechanisms of action. Although the blood pressure-lowering effect of ACE inhibitors and ARBs is equivalent to that of most other anti hypertensive agents, emerging data suggest that these drug classes may have a greater effect on decreasing cardiovascular morbidity and, mortality rates in specific patient populations.Methods We reviewed large (approximately greater than or equal to5000 patients) hypertension clinical trials using ACE inhibitors and ARBs and with cardiovascular morbidity/mortality end points.Results Six trials of ACE inhibitors and 5 trials of ARBs (3 completed, 2 ongoing) were selected for this analysis. Data from these hypertension mega-trials suggest that ACE inhibitors and ARBs may decrease cardiovascular morbidity and mortality rates, especially in patients with diabetes mellitus, renal dysfunction, and left ventricular hypertrophy. However, some trials showed important blood-pressure differences and are therefore partly inconclusive for particular drug effects.Conclusions Analysis of recently reported and ongoing mega-trials of renin-angiotensin-aldosterone system inhibitors may support the notion that their vasculoprotective properties confer greater benefit by virtue of their effects beyond blood-pressure reduction. Results from trials that will be completed in the next few years may provide further support of blocking the renin-angiotensin-system in cardiovascular protection in the management of hypertension.