Blood pressure-lowering drugs and secondary prevention of cardiovascular disease: systematic review and meta-analysis.
Blood pressure-lowering drugs and secondary prevention of cardiovascular disease: systematic review and meta-analysis.
复制标题
降血压药物与心血管疾病二级预防：系统评价和荟萃分析。
DOI：
10.1097/hjh.0000000000001720
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发表时间：
2018
影响因子：
4.9
通讯作者：
Xie W
中科院分区：
文献类型：
--
作者：
Xie W
目的：系统评价5种常用降压药在非急性心血管疾病但无心力衰竭患者中减少心血管事件的疗效。方法：我们检索了PubMed、EMBASE和科克伦对照试验中心数据库，检索日期为2017年3月18日。主要结局为致死性和非致死性心血管事件，次要结局为全因死亡、致死性和非致死性心肌梗死以及卒中。合并的风险比和相应的95%置信区间（CI）计算使用Mantel-Haenszel随机效应荟萃analysis.Results：27随机对照试验，143095名参与者和治疗持续时间至少12个月，包括在我们的分析。15项试验招募了冠状动脉疾病患者，8项招募了脑动脉疾病患者，4项招募了心血管疾病患者。在27项试验中，10项试验仅包括高血压患者。与安慰剂相比，血管紧张素转换酶抑制剂（ACEIs）（风险比0.85，95% CI 0.78-0.92）、血管紧张素受体阻滞剂（风险比0.92，95% CI 0.87-0.98）和利尿剂（风险比0.77，95% CI 0.66-0.90）显著降低心血管事件的风险。除此之外，ACEI显著降低了所有次要结局，钙通道阻滞剂和利尿剂显著降低了卒中。没有显着差异被发现在头对头比较每个给定的药物类与任何其他class.Conclusions：虽然只有ACEI有证据表明其效果在减少心血管事件和所有次要结局，头对头比较没有提供强有力的证据，这些降压药物之间的影响差异。
Objective:To systematically evaluate the efficacy of five commonly used blood pressure-lowering drugs in reducing cardiovascular events among patients with nonacute cardiovascular disease, but without heart failure.Methods:We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials on 18 March 2017. The primary outcome was fatal and nonfatal cardiovascular events, and the secondary outcomes were all-cause death, fatal and nonfatal myocardial infarction, and stroke. Pooled risk ratios and corresponding 95% confidence intervals (CIs) were calculated using Mantel–Haenszel random-effects meta-analyses.Results:Twenty-seven randomized controlled trials with 143 095 participants and a treatment duration of at least 12 months were included in our analyses. Fifteen trials enrolled patients with coronary artery disease, eight enrolled patients with cerebral artery disease, and four enrolled patients with cardiovascular disease. Of the 27 trials, 10 trials only included hypertensive patients. Compared with placebo, angiotensin-converting enzyme inhibitors (ACEIs)(risk ratio 0.85, 95% CI 0.78–0.92), angiotensin receptor blockers (risk ratio 0.92, 95% CI 0.87–0.98), and diuretics (risk ratio 0.77, 95% CI 0.66–0.90) significantly reduced the risk of cardiovascular events. Apart from this, ACEIs significantly reduced all secondary outcomes, calcium channel blockers, and diuretics reduced stroke significantly. No significant difference was found in head-to-head comparisons of each given drug class with any other class.Conclusions:Although only ACEIs have evidences showing its effect in reducing cardiovascular events and all secondary outcomes, head-to-head comparisons did not provide strong evidence in difference in the effects between these blood pressure-lowering drugs.