Li Shuang, Wu Yan, Yu Ge, Xia Qing, Xu Yawei
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
PLoS One. 2014 Mar 3;9(3):e90217. doi: 10.1371/journal.pone.0090217. eCollection 2014.
OBJECTIVE(S): Several studies have assessed the effect of angiotensin II receptor blockers (ARBs) on peripheral endothelial dysfunction as measured by flow-mediated vasodilatation (FMD), a widely-used indicator for endothelial function. We conducted a meta-analysis to investigate the effect in comparison to placebo or no treatment and other antihypertensives.
MEDLINE, Cochrane library and EMBASE were searched to September 2013 for randomized controlled trials (RCTs) that assessed the effect of ARBs versus placebo or no treatment and other antihypertensives (angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), β-blockers, diuretics) by forearm FMD. Furthermore, we also use meta-regression to analyze the relationship between the endothelial function and the duration of ARBs treatments.
In 11 trials including 590 patients, ARBs (n = 315) significantly improved FMD (1.36%, 95% confidence internal [CI]:1.28 to 1.44) versus placebo or no treatment (n = 275). In 16 trials that included 1028 patients, ARBs (n = 486) had a significant effect (0.59%, 95% CI: 0.25 to 0.94) on FMD when compared with other antihypertensives (n = 542). In 8 trials, ARBs (n = 174) had no significant effect (-0.14%, 95% CI: -0.32 to 0.03) compared with ACEI (n = 173). Compared with others, the benefits of ARBs, respectively, were 1.67% (95% CI: 0.65 to 0.93) in 7 trials with CCBs, 0.79% (95% CI: 0.42 to 1.01) with β-blockers in 3 trials and 0.9% (95% CI: 0.77 to 1.03) with diuretics in 3 trials. Importantly, we found ARBs were less effective in a long time span (95% CI: -1.990 to -0.622) than the first 6 months (95% CI: -0.484 to 0.360).
This study shows that ARBs improve peripheral endothelial function and are superior to CCBs, β-blockers and diuretics. However, the effect couldn't be maintained for a long time. In addition, there was no significant difference between ARBs and ACEI.
多项研究评估了血管紧张素II受体阻滞剂（ARB）对通过血流介导的血管舒张（FMD）测量的外周内皮功能障碍的影响，FMD是一种广泛使用的内皮功能指标。我们进行了一项荟萃分析，以研究与安慰剂或不治疗以及其他抗高血压药物相比的效果。
检索MEDLINE、Cochrane图书馆和EMBASE至2013年9月的随机对照试验（RCT），这些试验通过前臂FMD评估ARB与安慰剂或不治疗以及其他抗高血压药物（血管紧张素转换酶抑制剂（ACEI）、钙通道阻滞剂（CCB）、β受体阻滞剂、利尿剂）的效果。此外，我们还使用荟萃回归分析内皮功能与ARB治疗持续时间之间的关系。
在11项包括590例患者的试验中，与安慰剂或不治疗（n = 275）相比，ARB（n = 315）显著改善了FMD（1.36%，95%置信区间[CI]：1.28至1.44）。在16项包括1028例患者的试验中，与其他抗高血压药物（n = 542）相比，ARB（n = 486）对FMD有显著影响（0.59%，95%CI：0.25至0.94）。在8项试验中，与ACEI（n = 173）相比，ARB（n = 174）没有显著影响（-0.14%，95%CI：-0.32至0.03）。与其他药物相比，ARB在7项与CCB的试验中的益处分别为1.67%（95%CI：0.65至0.93），在3项与β受体阻滞剂的试验中为0.79%（95%CI：0.42至1.01），在3项与利尿剂的试验中为0.9%（95%CI：0.77至1.03）。重要的是，我们发现ARB在较长时间跨度（95%CI：-1.990至-0.622）内的效果不如前6个月（95%CI：-0.484至0.360）。
本研究表明，ARB可改善外周内皮功能，优于CCB、β受体阻滞剂和利尿剂。然而，这种效果不能长期维持。此外，ARB与ACEI之间没有显著差异。
