Shih Chia-Jen, Chen Hung-Ta, Chao Pei-Wen, Kuo Shu-Chen, Li Szu-Yuan, Yang Chih-Yu, Tarng Der-Cherng, Ou Shuo-Ming, Chen Yung-Tai
aSchool of Medicine, National Yang-Ming University, Taipei bDepartment of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan cDeran Clinic, Yilan dDivision of Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch eDepartment of Anesthesiology, Wan Fang Hospital, Taipei Medical University fSchool of Medicine, Taipei Medical University, Taipei gNational Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County hDivision of Infectious Diseases, Taipei Veterans General Hospital iDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital jDivision of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan *Chia-Jen Shiha and Hung-Ta Chen contributed equally to the writing of this article. †Yung-Tai Chen and Shuo-Ming Ou contributed equally as corresponding authors to this work.
J Hypertens. 2016 Mar;34(3):567-74; discussion 575. doi: 10.1097/HJH.0000000000000804.
Renin-angiotensin-aldosterone system blockers are the preferred antihypertensive medications in patients with diabetes and prior stroke. This study aimed to compare the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in terms of major adverse cardiac events (MACEs) in patients with diabetes who survived ischemic stroke.
We conducted an observational, nationwide, propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. Patients aged at least 20 years with type 2 diabetes who initiated ACEI (n = 15,959) or ARB (n = 23,929) use within 90 days after discharge for first ischemic stroke between January 2000 and December 2011 were allocated to ACEI and ARB groups, respectively. The primary outcomes were MACEs (myocardial infarction, ischemic stroke, and cardiovascular mortality). The secondary outcomes were hospitalization for acute kidney injury and hyperkalemia. Intention-to-treat and as-treated models were used.
Intention-to-treat analysis showed no significant difference between the ACEI and ARB groups in the outcomes of MACEs [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.95-1.04], including ischemic stroke (HR, 1.01; 95% CI, 0.97-1.06), myocardial infarction (HR, 1.06; 95% CI, 0.95-1.18), and cardiovascular mortality (HR, 0.98; 95% CI, 0.91-1.06). As-treated analysis produced similar results. Additionally, the groups showed no difference in the risk of hospitalization for acute kidney injury or hyperkalemia.
Our study supports the hypothesis that the risks of MACEs and two additional secondary outcomes in patients with diabetes who survived ischemic stroke did not differ according to ACEI versus ARB use.
肾素 - 血管紧张素 - 醛固酮系统阻滞剂是糖尿病合并既往卒中患者的首选降压药物。本研究旨在比较血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）对缺血性卒中存活的糖尿病患者主要不良心脏事件（MACE）的影响。
我们利用台湾国民健康保险研究数据库进行了一项全国性的观察性倾向评分匹配队列研究。2000年1月至2011年12月期间，首次缺血性卒中出院后90天内开始使用ACEI（n = 15959）或ARB（n = 23929）的至少20岁的2型糖尿病患者分别被分配到ACEI组和ARB组。主要结局是MACE（心肌梗死、缺血性卒中和心血管死亡）。次要结局是急性肾损伤和高钾血症住院。采用意向性分析和实际治疗分析模型。
意向性分析显示，ACEI组和ARB组在MACE结局方面无显著差异[风险比（HR），0.99；95%置信区间（CI），0.95 - 1.04]，包括缺血性卒中（HR，,1.01；95%CI，0.97 - 1.06）、心肌梗死（HR，1.06；95%CI，0.95 - 1.18）和心血管死亡（HR，0.98；95%CI，0.91 - 1.06）。实际治疗分析产生了类似的结果。此外，两组在急性肾损伤或高钾血症住院风险方面没有差异。
我们的研究支持以下假设：缺血性卒中存活的糖尿病患者中，使用ACEI与ARB在MACE风险及另外两个次要结局方面没有差异。
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