Cardiac Catheterization Laboratory, New York University School of Medicine, Leon H Charney Division of Cardiology, NY 10016, USA.
BMJ. 2011 Apr 26;342:d2234. doi: 10.1136/bmj.d2234.
To evaluate the cardiovascular outcomes and other outcomes associated with angiotensin receptor blockers.
Systematic review of randomised controlled trials with meta-analysis and trial sequential analysis (TSA).
Pubmed, Embase, and CENTRAL searches for randomised clinical trials, until August 2010, of angiotensin receptor blockers compared with controls (placebo/active treatment) that enrolled at least 100 participants and had a follow-up of at least one year.
Myocardial infarction, death, cardiovascular death, angina pectoris, stroke, heart failure, and new onset diabetes.
37 randomised clinical trials included 147,020 participants and had a total follow-up of 485,166 patient years. When compared with controls (placebo/active treatment), placebo, or active treatment, angiotensin receptor blockers were not associated with an increase in the risk of myocardial infarction (relative risk 0.99, 95% confidence interval 0.92 to 1.07), death, cardiovascular death, or angina pectoris. Compared with controls, angiotensin receptor blockers were associated with a reduction in the risk of stroke (0.90, 0.84 to 0.98), heart failure (0.87, 0.81 to 0.93), and new onset diabetes (0.85, 0.78 to 0.93), with similar results when compared with placebo or with active treatment. Based on trial sequential analysis, there is no evidence even for an average 5.0-7.5% (upper confidence interval 5-11%) relative increase in myocardial infarction (absolute increase of 0.3%), death, or cardiovascular death with firm evidence for relative risk reduction of stroke (at least 1%, average 10%) (compared with placebo only), heart failure (at least 5%, average 10%), and new onset diabetes (at least 4%, average 10%) with angiotensin receptor blockers compared with controls.
This large and comprehensive analysis produced firm evidence to refute the hypothesis that angiotensin receptor blockers increase the risk of myocardial infarction (ruling out even a 0.3% absolute increase). Compared with controls, angiotensin receptor blockers reduce the risk of stroke, heart failure, and new onset diabetes.
评估血管紧张素受体阻滞剂相关的心血管结局和其他结局。
对随机对照试验进行系统评价，并进行荟萃分析和试验序贯分析（TSA）。
在 2010 年 8 月之前，使用 Pubmed、Embase 和 CENTRAL 搜索随机临床试验，将血管紧张素受体阻滞剂与对照组（安慰剂/活性治疗）进行比较，至少纳入 100 名参与者，随访时间至少为一年。
心肌梗死、死亡、心血管死亡、心绞痛、卒中和心力衰竭、新发糖尿病。
37 项随机临床试验纳入了 147020 名参与者，总随访时间为 485166 患者年。与对照组（安慰剂/活性治疗）相比，安慰剂或活性治疗并未增加血管紧张素受体阻滞剂发生心肌梗死（相对风险 0.99，95%置信区间 0.92 至 1.07）、死亡、心血管死亡或心绞痛的风险。与对照组相比，血管紧张素受体阻滞剂可降低卒中（0.90，0.84 至 0.98）、心力衰竭（0.87，0.81 至 0.93）和新发糖尿病（0.85，0.78 至 0.93）的风险，与安慰剂或活性治疗相比，结果相似。基于试验序贯分析，即使对于心肌梗死（绝对增加 0.3%）、死亡或心血管死亡的平均 5.0%至 7.5%（上置信区间 5%至 11%）的相对增加，也没有证据表明其风险增加，而对卒中（至少 1%，平均 10%）、心力衰竭（至少 5%，平均 10%）和新发糖尿病（至少 4%，平均 10%）的相对风险降低则有确凿证据，血管紧张素受体阻滞剂与对照组相比具有优势。
这项大型且全面的分析提供了确凿的证据，驳斥了血管紧张素受体阻滞剂增加心肌梗死风险的假说（甚至排除了绝对增加 0.3%的可能性）。与对照组相比，血管紧张素受体阻滞剂可降低卒中、心力衰竭和新发糖尿病的风险。
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