Kistner Iris, Zeymer Uwe, Dechend Ralf, Hagedorn Ina, Riemer Thomas, Bramlage Peter, Pittrow David, Senges Jochen, Schmieder Roland E
Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany.
Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
J Clin Hypertens (Greenwich). 2016 Oct;18(10):1045-1053. doi: 10.1111/jch.12828. Epub 2016 Apr 20.
The authors sought to retrospectively analyze the real-world evidence on aliskiren in diabetic patients with or without concomitant renin-angiotensin system (RAS) blocker use based on the Registry for Ambulant Therapy With RAS Inhibitors in Hypertension Patients in Germany (3A). Of 14,986 patients included, 3772 patients had diabetes and 28.5% received aliskiren, 14.3% received angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), 35.4% received aliskiren plus an ACE inhibitor/ARB, and 10.5% received other drugs. Ambulatory blood pressure (BP) monitoring (baseline BP 148±15.8/84.0±10.9 mm Hg) revealed stronger diastolic BP reduction for aliskiren plus ACE inhibitor/ARB than aliskiren alone in the low (2.8±0.5 vs 0.6±0.6; P=.004) and intermediate (5.9±0.5 vs 4.5±0.5; P=.04) baseline BP groups. There was a lesser ambulatory BP reduction observed for patients receiving non-RAS in the high baseline category for both systolic (12.5±1.8 vs 17.1±1.0; P=.02) and diastolic (6.9±1.0 vs 9.8±0.6; P=.01) BP. In patients with hypertension and type 2 diabetes, aliskiren was beneficial in lowering BP, with no observed increases in major adverse effects compared with RAS-blocking therapy alone.
作者试图基于德国高血压患者RAS抑制剂门诊治疗登记系统（3A），对使用或未使用肾素-血管紧张素系统（RAS）阻滞剂的糖尿病患者中阿利吉仑的真实世界证据进行回顾性分析。在纳入的14986例患者中，3772例患有糖尿病，28.5%接受阿利吉仑治疗，14.3%接受血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）治疗，35.4%接受阿利吉仑加ACE抑制剂/ARB治疗，10.5%接受其他药物治疗。动态血压（BP）监测（基线血压148±15.8/84.0±10.9 mmHg）显示，在低（2.8±0.5 vs 0.6±0.6；P = 0.004）和中度（5.9±0.5 vs 4.5±0.5；P = 0.04）基线血压组中，阿利吉仑加ACE抑制剂/ARB比单独使用阿利吉仑能更显著降低舒张压。在高基线类别中，接受非RAS治疗的患者收缩压（12.5±1.8 vs 17.1±1.0；P = 0.02）和舒张压（6.9±1.0 vs 9.8±0.6；P = 0.01）的动态血压降低幅度较小。在高血压合并2型糖尿病患者中，阿利吉仑有助于降低血压，与单独使用RAS阻断疗法相比，未观察到主要不良反应增加。
