Department of Neurology, Federation of National Personnel Mutual Aid Associations Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo, 190-8531, Japan.
Adv Ther. 2012 Oct;29(10):900-12. doi: 10.1007/s12325-012-0049-1. Epub 2012 Sep 14.
Angiotensin-converting enzyme inhibitors (ACEIs) are reported to reduce the incidence of aspiration pneumonia in hypertensive patients. In this study, a metaanalysis was conducted to obtain statistically more reliable estimates of outcome.
The MEDLINE and JMEDICINE databases were searched and the following study selection criteria were applied: (1) comparative controlled studies identified with the following keywords: drug therapy, ACEI, hypertension, swallowing function, dysphagia, stroke, and pneumonia; (2) a minimum follow-up period of 6 months; and (3) a minimum number of patients of more than 100. Patients with hypertension and a history of stroke or transient ischemic attack (TIA) in five controlled studies that reported the incidence of pneumonia were included in the analysis.
A total of 8,693 post-stroke patients were given ACEIs with another antihypertensive agent or placebo as a control. In all studies, ACEIs, particularly imidapril, exhibited preventive effects equating to a relative risk that ranged from 0.32 to 0.81 compared with controls. In the combined studies the overall relative risk of ACEI-treated patients versus controls was 0.61 (95% confidence intervals [CI] 0.51-0.75; P < 0.001). Among Asian patients, the relative risk was 0.42 (95% CI 0.32-0.56; P < 0.001). Among Japanese patients, an even greater preventive effect was found for ACEIs versus other antihypertensives (relative risk: 0.38 [95% CI 0.27-0.54; P < 0.001]).
ACEIs appear to be more effective than other antihypertensive agents or placebo in reducing pneumonia risk in post-stroke patients, especially in Asian populations.
血管紧张素转换酶抑制剂（ACEIs）据报道可降低高血压患者发生吸入性肺炎的发生率。本研究进行了荟萃分析，以获得更可靠的统计学结果。
检索 MEDLINE 和 JMEDICINE 数据库，并应用以下研究选择标准：（1）使用以下关键词识别的比较对照研究：药物治疗、ACEI、高血压、吞咽功能、吞咽困难、中风和肺炎；（2）随访时间至少 6 个月；（3）患者人数至少 100 例。纳入五项对照研究的分析，这些研究报告了肺炎的发生率，且纳入了患有高血压且有中风或短暂性脑缺血发作（TIA）病史的患者。
共有 8693 名中风后患者接受 ACEI 与另一种降压药或安慰剂作为对照治疗。在所有研究中，ACEI，特别是咪达普利，表现出预防作用，与对照组相比，相对风险范围为 0.32 至 0.81。在综合研究中，ACEI 治疗患者与对照组的总体相对风险为 0.61（95%置信区间[CI] 0.51-0.75；P<0.001）。在亚洲患者中，相对风险为 0.42（95%CI 0.32-0.56；P<0.001）。在日本患者中，ACEI 与其他降压药相比，预防效果更为显著（相对风险：0.38 [95%CI 0.27-0.54；P<0.001）。
ACEI 似乎比其他降压药或安慰剂更能降低中风后患者肺炎的风险，尤其是在亚洲人群中。
