Ovbiagele B, Kidwell C S, Starkman S, Selco S L, Rajajee V, Razinia T, Saver J L
Stroke Center, Department of Neurology, Olive View-UCLA Medical Center, Los Angeles, CA, USA.
Neurology. 2005 Sep 27;65(6):851-4. doi: 10.1212/01.wnl.0000175984.29283.6d.
Drugs that increase angiotensin 2 formation, including thiazides, calcium channel blockers, and angiotensin 2 type 1 (AT1) receptor blockers, may be more effective in stroke prevention than angiotensin 2 suppressive drugs such as angiotensin-converting enzyme inhibitors and beta-blockers.
To assess whether angiotensin 2 formation increasing drugs reduce incident stroke severity compared with angiotensin 2 formation suppressive drugs.
Consecutive patients presenting within 24 hours of first-ever ischemic stroke over an 18-month period were studied. Subjects were only included if they were on only angiotensin 2 formation increasers, only angiotensin 2 formation suppressors, or no antihypertensive agents. NIH Stroke Scale (NIHSS) score at presentation was used as the index of stroke severity. Demographic data, risk factors, admission blood pressures, other medications, and stroke mechanisms were controlled for across the three groups using least absolute deviation linear regression.
One hundred seventy-five individuals met study criteria. Mean age was 67.4 years; 45% were women. Forty-nine patients were on angiotensin 2 formation suppressors and 16 on angiotensin 2 formation increasers. Age at admission, atrial fibrillation, previous antithrombotic use, cardioembolic and large-vessel atherosclerotic mechanisms, and mean systolic and diastolic blood pressure were significant univariate predictors of presenting median NIHSS score. On multivariate analysis, the adjusted median NIHSS score was lower in the angiotensin 2 increasers (median = 2.2; p = 0.005) and trended lower for angiotensin 2 suppressors (median = 4.4; p = 0.054) compared with the no-antihypertensive group (median = 6.0). There was no difference in stroke severity between angiotensin 2 increasers compared with angiotensin 2 suppressors (p = 0.123).
Angiotensin 2 formation increasing agents did not reduce ischemic stroke severity more than angiotensin 2 formation suppressing agents. However, the prestroke use of antihypertensives was associated with reduced severity of incident ischemic strokes.
包括噻嗪类、钙通道阻滞剂和血管紧张素2 1型（AT1）受体阻滞剂在内的增加血管紧张素2生成的药物，在预防中风方面可能比血管紧张素转换酶抑制剂和β受体阻滞剂等抑制血管紧张素2的药物更有效。
评估与抑制血管紧张素2生成的药物相比，增加血管紧张素2生成的药物是否能降低首次发生缺血性中风的严重程度。
对在18个月内首次发生缺血性中风24小时内就诊的连续患者进行研究。仅当受试者仅服用增加血管紧张素2生成的药物、仅服用抑制血管紧张素2生成的药物或未服用抗高血压药物时才纳入研究。就诊时的美国国立卫生研究院卒中量表（NIHSS）评分用作中风严重程度的指标。使用最小绝对偏差线性回归对三组的人口统计学数据、危险因素、入院血压、其他药物和中风机制进行控制。
175名个体符合研究标准。平均年龄为67.4岁；45%为女性。49名患者服用抑制血管紧张素2生成的药物，16名患者服用增加血管紧张素2生成的药物。入院年龄、心房颤动、既往抗栓药物使用、心源性栓塞和大动脉粥样硬化机制以及平均收缩压和舒张压是就诊时NIHSS中位数评分的显著单因素预测指标。多因素分析显示，与未服用抗高血压药物组（中位数=6.0）相比，增加血管紧张素2生成的药物组调整后的NIHSS中位数评分较低（中位数=2.2；p=0.005），抑制血管紧张素2生成的药物组呈下降趋势（中位数=4.4；p=0.054）。增加血管紧张素2生成的药物与抑制血管紧张素2生成的药物在中风严重程度上无差异（p=0.123）。
增加血管紧张素生成的药物在降低缺血性中风严重程度方面并不比抑制血管紧张素2生成的药物更有效。然而，中风前使用抗高血压药物与降低首次发生缺血性中风的严重程度相关。
