Peng Feng, Pan Hongming, Wang Bin, Lin Jinxiu, Niu Wenquan
Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Basic Medical Science College, Qiqihar Medical University, Qiqihar, Heilongjiang, China.
Hypertens Res. 2015 Sep;38(9):613-20. doi: 10.1038/hr.2015.51. Epub 2015 Apr 9.
Some studies reported a protective role of angiotensin receptor blockers (ARBs) against arterial stiffness. Therefore, we performed a meta-analysis of published clinical trials to systematically assess the impact of ARBs on arterial stiffness as measured by using pulse wave velocity (PWV). Eligible articles were identified by searching PubMed, EMBASE, Cochrane, Wanfang and CNKI databanks before 31 July 2014. The data were extracted independently and in duplicate. Forty articles including 53 clinical trials qualified, including 1650 and 1659 subjects in ARB treatment and control groups, respectively. Overall reductions in carotid-femoral PWV (cfPWV) and brachial-ankle PWV (baPWV) were statistically significant, with an average of -42.52 cm s(-1) (95% CI: -81.82 to -3.21; P=0.034) and -107.08 cm s(-1) (95% CI: -133.98 to -80.18; P<0.0005), respectively, after receiving ARBs. Subgroup analysis by ARB type revealed that telmisartan (weighted mean difference or WMD=-100.82 cm s(-1); P<0.0005) and valsartan (WMD=-104.59 cm s(-1); P<0.0005) significantly reduced baPWV, but only valsartan reduced cfPWV (WMD=-65.58; P=0.030). cfPWV was significantly reduced in comparisons of ARBs with placebo (WMD=-79.65 cm s(-1); P=0.001), and baPWV was significantly reduced with calcium channel blockers (WMD=-130.74 cm s(-1); P<0.0005). There were low probabilities of publication bias. Taken together, our findings support the important role of ARB treatment in improving arterial stiffness.
一些研究报道了血管紧张素受体阻滞剂（ARB）对动脉僵硬度具有保护作用。因此，我们开展了一项已发表临床试验的荟萃分析，以系统评估ARB对使用脉搏波速度（PWV）测量的动脉僵硬度的影响。通过检索2014年7月31日前的PubMed、EMBASE、Cochrane、万方和中国知网数据库来确定符合条件的文章。数据由两人独立且重复提取。40篇文章符合要求，包括53项临床试验，ARB治疗组和对照组分别有1650例和1659例受试者。接受ARB治疗后，颈股PWV（cfPWV）和臂踝PWV（baPWV）的总体降低具有统计学意义，平均分别为-42.52 cm·s-1（95%CI：-81.82至-3.21；P=0.034）和-107.08 cm·s-1（95%CI：-133.98至-80.18；P<0.0005）。按ARB类型进行的亚组分析显示，替米沙坦（加权平均差或WMD=-100.82 cm·s-1；P<0.0005）和缬沙坦（WMD=-104.59 cm·s-1；P<0.0005）可显著降低baPWV，但只有缬沙坦可降低cfPWV（WMD=-65.58；P=0.030）。与安慰剂比较时，cfPWV显著降低（WMD=-79.65 cm·s-1；P=0.001），与钙通道阻滞剂比较时，baPWV显著降低（WMD=-130.74 cm·s-1；P<0.0005）。发表偏倚的可能性较低。综上所述，我们的研究结果支持ARB治疗在改善动脉僵硬度方面的重要作用。
