Ong Hean Teik, Ong Loke Meng, Ho Jacqueline Judith
Consultant Cardiologist, HT Ong Heart Clinic, 251C Burma Road, Penang 10350, Malaysia.
ISRN Cardiol. 2013 Nov 6;2013:478597. doi: 10.1155/2013/478597.
Context. Whether angiotensin converting-enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are useful in high risk patients without heart failure is unclear. We perform a meta-analysis of prospective randomized placebo-controlled ACEI or ARB trials studying patients with a combination of risk factors to assess treatment impact on all cause mortality, cardiovascular mortality, nonfatal myocardial infarction (MI) and stroke. Method. A PubMed search was made for placebo-controlled trials recruiting at least 1,200 high risk patients randomized to either ACEI or ARB, with follow-up of at least 2 years. Meta-analysis was performed using the RevMan 5 program and Mantel-Haenszel analysis was done with a fixed effects model. Results. Ten trials recruiting 77,633 patients were reviewed. All cause mortality was significantly reduced by ACEI (RR 0.89; P = 0.0008), but not by ARB treatment (RR 1.00; P = 0.89). Cardiovascular mortality and nonfatal MI were also reduced in the ACEI trials but not with ARB therapy. Stroke was significantly reduced in the ACEI trials (RR 0.75; P < 0.00001) and more modestly reduced in the ARB trials (RR 0.90; P = 0.01). Conclusion. ACEI treatment reduced stroke, nonfatal MI, cardiovascular and total mortality in high risk patients, while ARB modestly reduced stroke with no effect on nonfatal MI, cardiovascular and total mortality.
背景。血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）对无心力衰竭的高危患者是否有用尚不清楚。我们对前瞻性随机安慰剂对照的ACEI或ARB试验进行了荟萃分析，这些试验研究了具有多种危险因素的患者，以评估治疗对全因死亡率、心血管死亡率、非致命性心肌梗死（MI）和中风的影响。方法。在PubMed上搜索安慰剂对照试验，这些试验招募了至少1200名随机分为ACEI或ARB的高危患者，随访时间至少为2年。使用RevMan 5程序进行荟萃分析，并采用固定效应模型进行Mantel-Haenszel分析。结果。对纳入77633例患者的10项试验进行了综述。ACEI可显著降低全因死亡率（RR 0.89；P = 0.0008），但ARB治疗无此效果（RR 1.00；P = 0.89）。ACEI试验中，心血管死亡率和非致命性MI也有所降低，但ARB治疗无此效果。ACEI试验中中风显著减少（RR 0.75；P < 0.00001），ARB试验中中风减少幅度较小（RR 0.90；P = 0.01）。结论。ACEI治疗可降低高危患者的中风、非致命性MI、心血管和全因死亡率，而ARB可适度降低中风，对非致命性MI、心血管和全因死亡率无影响。
