Spinar Jindrich, Vitovec Jiri, Soucek Miroslav
Department of Internal Medicine, Cardiology Division, University Hospital Brno, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014 Sep;158(3):412-21. doi: 10.5507/bp.2013.053. Epub 2013 Jul 29.
The primary questions asked by the MEDINA (MEtabolic parameters, DIabetes mellitus and NephropAthy) study are: 1) Do angiotensin converting enzyme inhibitors (ACE-I) have any advantages over angiotensin receptor blockers (ARB)? 2) Should the other drug for combination be a diuretic or a calcium-channel blocker (CCB)? 3) How are the risks reduced by the co administration of a statin?
A total of 439 hypertensive patients with metabolic syndrome and/or diabetes mellitus were randomized to 2 groups: group 1--ramipril (ACE-I) or perindopril and group 2--losartan (ARB). Hydrochlorothiazide (diuretic) or amlodipine (CCB) were added to both groups. As a third step, a statin was added.
Blood pressure decreased 24.1/13.3 mmHg in the ACE inhibitor group and 25.9/13.5 in the losartan group. The difference was insignificant. Adding either hydrochlorothiazide or amlodipin was equally effective. There were no significant differences on metabolic parameters in the trial arms. Cholesterol level decreased by 0.95 mmol/L in the ACE-I group and 1.02 mmol/L in the ARB group (ns).
MEDINA has so far confirmed the equivalence of ACE-I and ARB in hypertension treatment. Adding either diuretic or CCB was equally effective. Our data support the current recommendations on adding a statin to reduce cardiovascular risk.
MEDINA（代谢参数、糖尿病和肾病）研究提出的主要问题是：1）血管紧张素转换酶抑制剂（ACE-I）与血管紧张素受体阻滞剂（ARB）相比有何优势？2）联合使用的另一种药物应该是利尿剂还是钙通道阻滞剂（CCB）？3）联合使用他汀类药物如何降低风险？
总共439名患有代谢综合征和/或糖尿病的高血压患者被随机分为两组：第1组——雷米普利（ACE-I）或培哚普利，第2组——氯沙坦（ARB）。两组均添加氢氯噻嗪（利尿剂）或氨氯地平（CCB）。第三步，添加他汀类药物。
ACE抑制剂组血压下降24.1/13.3 mmHg，氯沙坦组血压下降25.9/13.5 mmHg。差异不显著。添加氢氯噻嗪或氨氯地平同样有效。试验组的代谢参数无显著差异。ACE-I组胆固醇水平下降0.95 mmol/L，ARB组下降1.02 mmol/L（无显著性差异）。
到目前为止，MEDINA证实了ACE-I和ARB在高血压治疗中的等效性。添加利尿剂或CCB同样有效。我们的数据支持目前关于添加他汀类药物以降低心血管风险的建议。
