高血压患者的降压治疗与心力衰竭的发生：一项针对高血压及心血管高危患者研究的贝叶斯网络荟萃分析
Antihypertensive treatment and development of heart failure in hypertension: a Bayesian network meta-analysis of studies in patients with hypertension and high cardiovascular risk.
作者信息
Sciarretta Sebastiano, Palano Francesca, Tocci Giuliano, Baldini Rossella, Volpe Massimo
机构信息
Department of Cardiology, Second Faculty of Medicine, University of Rome La Sapienza, S. Andrea Hospital, Rome, Italy.
出版信息
Arch Intern Med. 2011 Mar 14;171(5):384-94. doi: 10.1001/archinternmed.2010.427. Epub 2010 Nov 8.
BACKGROUND
It is still debated whether there are differences among the various antihypertensive strategies in heart failure prevention. We performed a network meta-analysis of recent trials in hypertension aimed at investigating this issue.
METHODS
Randomized, controlled trials published from 1997 through 2009 in peer-reviewed journals indexed in the PubMed and EMBASE databases were selected. Selected trials included patients with hypertension or a high-risk population with a predominance of patients with hypertension.
RESULTS
A total of 223,313 patients were enrolled in the selected studies. Network meta-analysis showed that diuretics (odds ratio [OR], 0.59; 95% credibility interval [CrI], 0.47-0.73), angiotensin-converting enzyme (ACE) inhibitors (OR, 0.71; 95% CrI, 0.59-0.85) and angiotensin II receptor blockers (ARBs) (OR, 0.76; 95% CrI, 0.62-0.90) represented the most efficient classes of drugs to reduce the heart failure onset compared with placebo. On the one hand, a diuretic-based therapy represented the best treatment because it was significantly more efficient than that based on ACE inhibitors (OR, 0.83; 95% CrI, 0.69-0.99) and ARBs (OR, 0.78; 95% CrI, 0.63-0.97). On the other hand, diuretics (OR, 0.71; 95% CrI, 0.60-0.86), ARBs (OR, 0.91; 95% CrI, 0.78-1.07), and ACE inhibitors (OR, 0.86; 95% CrI, 0.75-1.00) were superior to calcium channel blockers, which were among the least effective first-line agents in heart failure prevention, together with β-blockers and α-blockers.
CONCLUSIONS
Diuretics represented the most effective class of drugs in preventing heart failure, followed by renin-angiotensin system inhibitors. Thus, our findings support the use of these agents as first-line antihypertensive strategy to prevent heart failure in patients with hypertension at risk to develop heart failure. Calcium channel blockers and β-blockers were found to be less effective in heart failure prevention.
背景
在预防心力衰竭方面，各种抗高血压策略之间是否存在差异仍存在争议。我们对近期高血压试验进行了网状荟萃分析，旨在研究这一问题。
方法
选取1997年至2009年在PubMed和EMBASE数据库中索引的同行评审期刊上发表的随机对照试验。入选试验包括高血压患者或高血压患者占多数的高危人群。
结果
共有223,313名患者纳入所选研究。网状荟萃分析表明，与安慰剂相比，利尿剂（比值比[OR]，0.59；95%可信度区间[CrI]，0.47 - 0.73）、血管紧张素转换酶（ACE）抑制剂（OR，0.71；95% CrI，0.59 - 0.85）和血管紧张素II受体阻滞剂（ARBs）（OR，0.76；95% CrI，0.62 - 0.90）是降低心力衰竭发病风险最有效的药物类别。一方面，基于利尿剂的治疗是最佳治疗方法，因为它比基于ACE抑制剂的治疗（OR，0.83；95% CrI，0.69 - 0.99）和基于ARBs的治疗（OR，0.78；95% CrI，0.63 - 0.97）显著更有效。另一方面，利尿剂（OR，0.71；95% CrI，0.60 - 0.86）、ARBs（OR，0.91；95% CrI，0.78 - 1.07）和ACE抑制剂（OR，0.86；95% CrI，0.75 - 1.00）优于钙通道阻滞剂，钙通道阻滞剂与β受体阻滞剂和α受体阻滞剂一样，是预防心力衰竭最无效的一线药物之一。
结论
利尿剂是预防心力衰竭最有效的药物类别，其次是肾素-血管紧张素系统抑制剂。因此，我们的研究结果支持将这些药物作为一线抗高血压策略，用于预防有发生心力衰竭风险的高血压患者发生心力衰竭。钙通道阻滞剂和β受体阻滞剂在预防心力衰竭方面效果较差。
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