導讀

卒中是美國人死亡的第二主要死因（編者注：在中國是第一死因），卒中獨立危險因素——藥物治療高血壓可顯著降低卒中發(fā)生率。雖然既往薈萃研究顯示，在減少卒中風險方面，不同種類的抗高血壓藥優(yōu)于安慰劑，但哪種最有效尚不明。美國學者們對此進行了薈萃分析，結(jié)果表明，在所有抗高血壓藥物中，鈣離子通道阻滯劑（CCB）在長期減少卒中發(fā)生方面最有效，而β受體阻滯劑與這種風險增加顯著相關(guān)。

卒中是美國人死亡的第二主要死因(編者注：在中國是第一死因)，卒中獨立危險因素——藥物治療高血壓可顯著降低卒中發(fā)生率。雖然既往薈萃研究顯示，在減少卒中風險方面，不同種類的抗高血壓藥優(yōu)于安慰劑，但哪種最有效尚不明。美國學者們對此進行了薈萃分析，結(jié)果表明，在所有抗高血壓藥物中，鈣離子通道阻滯劑(CCB)在長期減少卒中發(fā)生方面最有效，而β受體阻滯劑與這種風險增加顯著相關(guān)。

研究者們系統(tǒng)檢索了在1999至2014年發(fā)表的有關(guān)抗高血壓治療對卒中一級和或二級預防的隨機對照臨床試驗(RCT)，對比了五類降壓藥的效果，這五類藥物包括血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)、血管緊張素受體拮抗劑(ARB)、β受體阻滯劑、鈣離子通道阻滯劑(CCB)和噻嗪樣利尿劑(T-T LD)。

結(jié)果共納入251853例患者，女性11.4%，平均年齡67.2±6.8歲。接受ACEI、ARB、ACEI/ARB、β受體阻滯劑、CCB和T-TLD治療的患者數(shù)分別為52887、7278、60165、24099、 98950和68639例。平均隨訪時間為42.9 15個月。至研究結(jié)束時，每種抗高血壓藥物與其他所有抗高血壓藥物的總體卒中發(fā)生風險比值和計算得到的血壓差異見下表。

相關(guān)文章公布于美國心臟學會科學年會（ACC2015）上。

原文

Long-Term Hypertensive Therapy and Stroke Prevention: A Meta-Analysis

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March 15, 2015, 9:45 - 10:30 AM

Disclosures

Faculty Disclosures

Authors

Bertrand Njume Mukete, Mark Cassidy, Keith Ferdinand, Thierry LeJemtel, Tulane University School of Medicine, New Orleans, LA, USA

Abstract

Background:

Stroke yearly produces about 6.7 million worldwide deaths as the second leading cause. Pharmacotherapy for hypertension, an independent stroke risk factor, significantly reduces incidence. Although prior meta-analyses demonstrate various antihypertensive classes are superior to placebo in reducing stroke risk, which class is most effective is unclear.

Methods:

A systematic MEDLINE search included only randomized antihypertension controlled clinical trials (RCT) published between 1999-2014 in adults with stroke as a primary or secondary outcome. Five classes compared against all others were: angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers (B-blocker), calcium channel blockers (CCB), thiazide-thiazide like diuretics (T-TLD). Among 17 RTCs with 30 comparative arms, risk ratio assessed effect size and a fix and random model calculated summary effect size.

Result:

Among 251,853 total patients (46 11.4% female; mean age 67.2+- 6.8 years), there were 52,887; 7,278; 60,165; 24,099; 98,950; and 68,639 patients in the ACEI, ARB, ACEI/ARB, B-blocker, CCB and T-TLD groups respectively. The mean follow-up was 42.9 15 months. The study end calculated class Blood Pressure difference and summary stroke risk ratio for each class versus all others is depicted (figure 1).

Conclusion:

Among all classes, CCBs were most effective long-term in reducing stroke incidence, whereas B-blockers were associated with significantly increased risk.

參考文獻：Bertrand Njume Mukete,et al. Abstract Presented at: American College of Cardiology Scientific Session & Expo; March 15, 2015, 9:45 - 10:30 AM

來源：醫(yī)學論壇網(wǎng) 作者：小田 譯