Wong Martin C S, Tam Wilson W S, Wang Harry H X, Zhang Dexing, Cheung Clement S K, Yan Bryan P, Leeder Stephen R, Griffiths Sian M
School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; CUHK Shenzhen Research Institute, Chinese University of Hong Kong, Hong Kong, China.
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Int J Cardiol. 2015;190:384-8. doi: 10.1016/j.ijcard.2015.04.191. Epub 2015 Apr 24.
Lisinopril and perindopril are two commonly used first-line antihypertensive agents. Few studies compared their effectiveness in reducing the incidence of renal diseases and diabetes.
Adult patients who received new prescriptions of lisinopril or perindopril from 2001 to 2005 in all public hospitals and clinics in Hong Kong were included, and followed up for at least 2 years. Patients prescribed the angiotensin converting enzyme inhibitors (ACEIs) for <1 month were excluded. The incidence of admissions due to renal diseases and diabetes was evaluated. We used Cox proportional hazard regression models to assess hospital admissions as the outcome measures, adjusting for age, sex, socioeconomic status, service types, and the proportion of days covered as a measure of medication adherence. The regression models were constructed with propensity score matching to minimize indication biases.
20,252 eligible patients with an average age of 64.5 years (SD 15.0) were included. The admission rates 24 months within the date of index prescription due to renal diseases were 3.1% (lisinopril) and 2.3% (perindopril); and 9.6% (lisinopril) and 7.2% (perindopril) for diabetes. Except for admissions due to diabetes at 6 months, lisinopril users were significantly more likely to be admitted due to renal diseases (adjusted hazard ratios: 1.304 to 1.378) and diabetes (1.146 to 1.231) than perindopril users at all time points.
Patients prescribed different ACEIs might have a different incidence of hospital admissions. Future studies should be conducted to evaluate the comparative effectiveness of different ACEIs on various patient-centered outcomes by head-to-head randomized controlled trials.
赖诺普利和培哚普利是两种常用的一线抗高血压药物。很少有研究比较它们在降低肾脏疾病和糖尿病发病率方面的有效性。
纳入2001年至2005年在香港所有公立医院和诊所接受赖诺普利或培哚普利新处方的成年患者，并随访至少2年。排除服用血管紧张素转换酶抑制剂（ACEIs）少于1个月的患者。评估因肾脏疾病和糖尿病入院的发生率。我们使用Cox比例风险回归模型评估入院情况作为结局指标，并对年龄、性别、社会经济地位、服务类型以及作为药物依从性衡量指标的覆盖天数比例进行调整。通过倾向得分匹配构建回归模型以尽量减少指征偏倚。
纳入了20252例符合条件的患者，平均年龄为64.5岁（标准差15.0）。在索引处方日期后的24个月内，因肾脏疾病入院的发生率在赖诺普利组为3.1%，培哚普利组为2.3%；因糖尿病入院的发生率在赖诺普利组为9.6%，培哚普利组为7.2%。除了6个月时因糖尿病入院外，在所有时间点，赖诺普利使用者因肾脏疾病（调整后的风险比：1.304至1.378）和糖尿病（1.146至1.231）入院的可能性均显著高于培哚普利使用者。
开具不同ACEIs的患者可能有不同的入院发生率。未来应通过直接头对头随机对照试验开展研究，以评估不同ACEIs对各种以患者为中心的结局的比较有效性。
