Brugts Jasper J, van Vark Laura, Akkerhuis Martijn, Bertrand Michel, Fox Kim, Mourad Jean-Jacques, Boersma Eric
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Int J Cardiol. 2015 Feb 15;181:425-9. doi: 10.1016/j.ijcard.2014.11.179. Epub 2014 Nov 26.
To assess the effectiveness of renin-angiotensin aldosterone system (RAAS) inhibitors to prevent all-cause and cardiovascular death, myocardial infarction and stroke in hypertensive patients considering the number needed to treat (NNT).
Data from a meta-analysis of 18 prospective, randomized, controlled morbidity-mortality trials (68 343 RAAS inhibitor; 84 543 control) were used to calculate NNTs for the prevention of all-cause and cardiovascular mortality, myocardial infarction, and stroke.
Angiotensin-converting enzyme (ACE) inhibitors were used in 7 trials and angiotensin receptor blockers (ARBs) in 11 trials. Mean follow-up was 4.3years. The annual incidence rate of all-cause mortality was 0.0233 in patients randomized to RAAS inhibitors versus 0.0252 in controls (hazard ratio 0.95, 95% confidence interval 0.91 to 0.99). The corresponding median NNT to prevent one death was 113 (2.5-97.5th percentile, 85 to 168) in favor of RAAS inhibitors, which was driven by ACE inhibitors (NNT 67, 2.5-97.5th percentile, 53 to 92) rather than ARBs (NNT 335, 2.5-97.5th percentile, -4341 to 5076). Results for cardiovascular mortality (NNT 116 for ACE inhibitors and 409 for ARBs, respectively) and myocardial infarction (NNT 80 and 338, respectively) also appeared to be driven by ACE inhibitors. We found a lower NNT for stroke in favor of ARB (NNT 337 and 131, respectively) although this difference was statistically non-significant.
Among hypertensive patients, ACE inhibitors but not ARBs, substantially reduce all-cause and cardiovascular mortality and myocardial infarction.
考虑治疗所需人数（NNT），评估肾素-血管紧张素-醛固酮系统（RAAS）抑制剂预防高血压患者全因死亡、心血管死亡、心肌梗死和中风的有效性。
来自18项前瞻性、随机、对照发病率-死亡率试验（68343例使用RAAS抑制剂；84543例为对照）的荟萃分析数据用于计算预防全因和心血管死亡、心肌梗死及中风的NNT。
7项试验使用了血管紧张素转换酶（ACE）抑制剂，11项试验使用了血管紧张素受体阻滞剂（ARB）。平均随访4.3年。随机接受RAAS抑制剂治疗的患者全因死亡率年发生率为0.0233，而对照组为0.0252（风险比0.95，95%置信区间0.91至0.99）。预防一例死亡的相应中位数NNT为113（第2.5至97.5百分位数，85至168），支持RAAS抑制剂，这主要由ACE抑制剂（NNT 67，第2.5至97.5百分位数，53至92）而非ARB（NNT 335，第2.5至97.5百分位数，-4341至5076）驱动。心血管死亡（ACE抑制剂和ARB的NNT分别为116和409）和心肌梗死（NNT分别为80和338）的结果似乎也由ACE抑制剂驱动。我们发现支持ARB的中风NNT较低（分别为337和131），尽管这种差异在统计学上不显著。
在高血压患者中，ACE抑制剂而非ARB能显著降低全因和心血管死亡率以及心肌梗死发生率。
