血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂对2型糖尿病高血压患者的影响：随机对照研究的荟萃分析
Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled studies.
作者信息
Hao Guang, Wang Zengwu, Guo Rui, Chen Zuo, Wang Xin, Zhang Linfeng, Li Wei
机构信息
Division of Prevention & Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No, 167 Beilishi Road Xicheng District, Beijing 100037, China.
出版信息
BMC Cardiovasc Disord. 2014 Oct 25;14:148. doi: 10.1186/1471-2261-14-148.
BACKGROUND
The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain. Our objective was to analyze the effects of ACE/ARBs, on the incidence of myocardial infarction, stroke, CV events, and all-cause mortality in hypertensive patients with T2 DM.
METHOD
PubMed and Embase databases were searched through January 2014 to identify studies meeting a priori inclusion criteria and references in the published articles were also reviewed. Two investigators independently extracted the information with either fixed-effect model or random-effect model to assess the effects of ACE/ARBs treatment in hypertensive patients with T2 DM.
RESULTS
Ten randomized controlled studies were included with a total of 21,871 participants. Overall, treatment with ACE/ARBs in hypertensive patients with T2 DM was associated with a statistically significant 10% reduction in CV events, pooled hazard ratio (HR) of 0.90 [95% confidence intervals (CI): 0.82-0.98] with no heterogeneity (I2 = 19.50%; P = 0.275);and 17% reduction in CV mortality, pooled HR of 0.83 [95% CI: 0.72-0.96] with no heterogeneity (I2 = 0.9%; P = 0.388). ACE/ARBs was not associated with MI, stroke and all-cause mortality.
CONCLUSIONS
Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM.
背景
血管紧张素转换酶（ACE）抑制剂和血管紧张素II受体阻滞剂（ARB）对2型糖尿病（T2 DM）高血压患者心血管（CV）风险的影响尚不确定。我们的目的是分析ACE/ARB对T2 DM高血压患者心肌梗死、中风、CV事件和全因死亡率的影响。
方法
检索截至2014年1月的PubMed和Embase数据库，以识别符合预先设定纳入标准的研究，并对已发表文章中的参考文献进行回顾。两名研究者独立提取信息，采用固定效应模型或随机效应模型评估ACE/ARB治疗对T2 DM高血压患者的影响。
结果
纳入10项随机对照研究，共21,871名参与者。总体而言，T2 DM高血压患者使用ACE/ARB治疗与CV事件发生率在统计学上显著降低10%相关，合并风险比（HR）为0.90 [95%置信区间（CI）：0.82 - 0.98]，无异质性（I2 = 19.50%；P = 0.275）；CV死亡率降低17%，合并HR为0.83 [95% CI：0.72 - 0.96]，无异质性（I2 = 0.9%；P = 0.388）。ACE/ARB与心肌梗死、中风和全因死亡率无关。
结论
ACE/ARB治疗可使T2 DM高血压患者的CV事件和死亡率显著降低。
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