Converting enzyme inhibitor or AT1-receptor blocker for decreasing long-term mortality in patients with stroke history and renal dysfunction?
Converting enzyme inhibitor or AT1-receptor blocker for decreasing long-term mortality in patients with stroke history and renal dysfunction?
复制标题
转换酶抑制剂或 AT1 受体阻滞剂可降低有中风病史和肾功能不全患者的长期死亡率？
DOI：
10.1161/01.str.0000044950.15362.a4
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发表时间：
2003
期刊：
影响因子：
8.3
通讯作者：
M. Andréjak
中科院分区：
文献类型：
--
作者：
A. Fournier;O. Godefroy;R. Oprisiu;M. Slama;M. Andréjak
致编辑：
MacWalter et al 1在其队列研究中提出肾功能不全是卒中患者死亡率的独立风险因素，因此强烈建议使用血管紧张素转换酶抑制剂（ACEI）降低死亡率。他们的建议基于HOPE研究，在该研究中，雷米普利与安慰剂相比，显著降低了肾功能不全患者和非肾功能不全患者的死亡率，2以及PROGRESS研究。然而，我们认为，使用这2项研究的结果并不完全适合支持这一独家建议，我们认为利尿剂和/或AT 1受体阻滞剂（ARB）的替代建议至少具有同等或更大的证据基础。
关于HOPE试验的使用，我们担心将其结果外推到作者研究的人群类型是不合适的，因为两项研究的基线特征在冠心病患病率方面有很大不同，HOPE的患病率为80%，而他们的队列研究仅为15%，而卒中史患病率的大小则相反（分别为11%和100%）。因此，HOPE中的心源性死亡可能比他们的队列研究（死亡的性质未定义）更普遍（考虑到心脏并发症的发生率是卒中的5倍）。
至于PROGRESS试验的使用，尽管冠心病的基线患病率相当，但它也不太合适......
To the Editor:
Having concluded their cohort study with the suggestion that renal dysfunction was an independent risk factor of mortality in patients having had a stroke, MacWalter et al1 strongly recommend the use of angiotensin-converting enzyme inhibitor (ACEI) to decrease this mortality. They base their recommendation on the HOPE study, in which ramipril comparatively with placebo significantly decreased mortality in both patients with and patients without renal dysfunction,2 and on the PROGRESS study. We think, however, that the use of the results of these 2 studies are not entirely appropriate for supporting this exclusive recommendation, alternative recommendation of diuretics and/or AT1-receptor blockers (ARB) having in our opinion at least equal or even greater evidence basis.
As regards the use of the HOPE trial, we fear that it is not appropriate to extrapolate its results to the kind of population the authors have studied because the baseline characteristics of the 2 studies are quite different regarding the prevalence of coronary heart disease, which was 80% in HOPE and only 15% in their cohort study, whereas the magnitude of stroke history prevalence was the opposite (11% and 100%, respectively). Cardiac death was therefore probably much more prevalent in HOPE (given that heart complication incidence was 5 times higher than that of stroke) than in their cohort study (for which the nature of death is not defined).
As regards the use of PROGRESS trial,3 it is also not quite appropriate despite comparable baseline prevalence of coronary heart disease …