Staessen Jan A, Li Yan, Thijs Lutgarde, Wang Ji-Guang
Study Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium.
Hypertens Res. 2005 May;28(5):385-407. doi: 10.1291/hypres.28.385.
In a meta-analysis published in June 2003, we reported that new and old classes of antihypertensive drugs had similar long-term efficacy and safety. Furthermore, we observed that in clinical trials in hypertensive or high-risk patients gradients in systolic blood pressure (SBP) accounted for most differences in outcome. To test whether our previous conclusions would hold, we updated our quantitative overview with new information from clinical trials published before 2005. To compare new and old antihypertensive drugs, we computed pooled odds ratios from stratified 2 x 2 contingency tables. In a meta-regression analysis, we correlated these odds ratios with corresponding between-group differences in SBP. We then contrasted observed odds ratios with those predicted from gradients in SBP. The main finding of our overview was that reduction in SBP largely explained cardiovascular outcomes in the recently published actively controlled trials in hypertensive patients and in placebo-controlled secondary prevention trials. The published results suggested that dihydropyridine calcium-channel blockers might offer a selective benefit in the prevention of stroke and inhibitors of the renin-angiotensin system in the prevention of heart failure. For prevention of myocardial infarction, the published results were more equivocal, because of the benefit of amlodipine over placebo or valsartan in 2 trials, whereas other placebo-controlled trials of calcium-channel blockers or angiotensin converting enzyme inhibitors did not substantiate the expected benefit with regard to cardiac outcomes. In conclusion, the hypothesis that new antihypertensive drugs might influence cardiovascular prognosis over and beyond their antihypertensive effect remains unproven. Our overview emphasizes the need of tight blood pressure control, but does not allow determining to what extent blood pressure must be lowered for optimal cardiovascular prevention.
在2003年6月发表的一项荟萃分析中，我们报告称新型和传统类别的抗高血压药物具有相似的长期疗效和安全性。此外，我们观察到在高血压或高危患者的临床试验中，收缩压（SBP）的梯度差异是导致预后差异的主要因素。为了检验我们之前的结论是否仍然成立，我们用2005年之前发表的临床试验的新信息更新了我们的定量综述。为了比较新型和传统抗高血压药物，我们从分层的2×2列联表中计算合并比值比。在一项荟萃回归分析中，我们将这些比值比与SBP组间的相应差异进行关联。然后，我们将观察到的比值比与根据SBP梯度预测的比值比进行对比。我们综述的主要发现是，在最近发表的高血压患者积极对照试验和安慰剂对照二级预防试验中，SBP的降低在很大程度上解释了心血管预后情况。已发表的结果表明，二氢吡啶类钙通道阻滞剂可能在预防中风方面具有选择性益处，而肾素 - 血管紧张素系统抑制剂在预防心力衰竭方面具有选择性益处。对于预防心肌梗死，已发表的结果更具争议性，因为在两项试验中氨氯地平相对于安慰剂或缬沙坦具有益处，而其他钙通道阻滞剂或血管紧张素转换酶抑制剂的安慰剂对照试验并未证实对心脏结局有预期的益处。总之，新型抗高血压药物可能在其降压作用之外影响心血管预后这一假设仍未得到证实。我们的综述强调了严格控制血压的必要性，但无法确定为实现最佳心血管预防血压必须降低到何种程度。
