Verdecchia Paolo, Reboldi Gianpaolo, Angeli Fabio, Gattobigio Roberto, Bentivoglio Maurizio, Thijs Lutgarde, Staessen Jan A, Porcellati Carlo
Dipartimento Malattie Cardiovascolari, Hospital R. Silvestrini, Località S. Andrea delle Fratte, 06100, Perugia, Italy.
Hypertension. 2005 Aug;46(2):386-92. doi: 10.1161/01.HYP.0000174591.42889.a2. Epub 2005 Jul 11.
We investigated whether protection from coronary heart disease (CHD) and stroke conferred by angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers (CCBs) in hypertensive or high-risk patients may be explained by the specific drug regimen. We extracted summary statistics regarding CHD and stroke from 28 outcome trials that compared either ACEIs or CCBs with diuretics, beta-blockers, or placebo for a total of 179,122 patients, 9509 incident cases of CHD, and 5971 cases of stroke. CHD included myocardial infarction and coronary death. In placebo-controlled trials, ACEIs decreased the risk of CHD (P<0.001), and CCBs reduced stroke incidence (P<0.001). There were no significant differences in CHD risk between regimens based on diuretics/beta-blockers and regimens based on ACEIs (P=0.46) or CCBs (P=0.52). The risk of stroke was reduced by CCBs (P=0.041) but not by ACEIs (P=0.15) compared with diuretics/beta-blockers. Because heterogeneity between trials was significant, we investigated potential sources of heterogeneity by metaregression. Examined covariates were the reduction in systolic blood pressure (BP), drug treatment (ACEIs versus CCBs), their interaction term, sex, age at randomization, year of publication, and duration of treatment. Prevention of CHD was explained by systolic BP reduction (P<0.001) and use of ACEIs (P=0.028), whereas prevention of stroke was explained by systolic BP reduction (P=0.001) and use of CCBs (P=0.042). These findings confirm that BP lowering is fundamental for prevention of CHD and stroke. However, over and beyond BP reduction, ACEIs appear superior to CCBs for prevention of CHD, whereas CCBs appear superior to ACEIs for prevention of stroke.
我们研究了血管紧张素转换酶抑制剂（ACEIs）和钙通道阻滞剂（CCBs）在高血压或高危患者中对冠心病（CHD）和中风的预防作用是否可由特定药物治疗方案来解释。我们从28项结局试验中提取了关于CHD和中风的汇总统计数据，这些试验将ACEIs或CCBs与利尿剂、β受体阻滞剂或安慰剂进行了比较，涉及总共179122名患者、9509例CHD事件和5971例中风病例。CHD包括心肌梗死和冠心病死亡。在安慰剂对照试验中，ACEIs降低了CHD风险（P<0.001），CCBs降低了中风发生率（P<0.001）。基于利尿剂/β受体阻滞剂的治疗方案与基于ACEIs的治疗方案（P=0.46）或CCBs的治疗方案（P=0.52）在CHD风险上无显著差异。与利尿剂/β受体阻滞剂相比，CCBs降低了中风风险（P=0.041），而ACEIs未降低中风风险（P=0.15）。由于试验间异质性显著，我们通过Meta回归研究了异质性的潜在来源。检查的协变量包括收缩压（BP）降低、药物治疗（ACEIs与CCBs）、它们的交互项、性别、随机分组时的年龄、发表年份和治疗持续时间。CHD的预防可由收缩压降低（P<0.001）和ACEIs的使用（P=0.028）来解释，而中风的预防可由收缩压降低（P=0.001）和CCBs的使用（P=0.042）来解释。这些发现证实血压降低是预防CHD和中风的基础。然而，除了血压降低之外，ACEIs在预防CHD方面似乎优于CCBs，而CCBs在预防中风方面似乎优于ACEIs。
