Remonti Luciana R, Dias Sofia, Leitão Cristiane B, Kramer Caroline K, Klassman Lucas P, Welton Nicky J, Ades A E, Gross Jorge L
Diabetes and Endocrinology Meta-Analysis (DEMA) group, Endocrinology Division, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Porto Alegre, Brazil.
School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK.
J Diabetes Complications. 2016 Aug;30(6):1192-200. doi: 10.1016/j.jdiacomp.2016.04.020. Epub 2016 Apr 29.
The aim of this study was to evaluate the effects of antihypertensive drug classes in mortality in patients with type 2 diabetes.
MEDLINE, EMBASE, Clinical Trials and Cochrane Library were searched for randomized trials comparing thiazides, beta-blockers, calcium channel blockers (CCBs), angiotensin-converting inhibitors (ACEi) and angiotensin-receptor blockers (ARBs), alone or in combination for hypertension treatment in patients with type 2 diabetes. Outcomes were overall and cardiovascular mortality. Network meta-analysis was used to obtain pooled effect estimate.
A total of 27 studies, comprising 49,418 participants, 5647 total and 1306 cardiovascular deaths were included. No differences in total or cardiovascular mortality were observed with isolated antihypertensive drug classes compared to each other or placebo. The ACEi and CCB combination showed evidence of reduction in cardiovascular mortality comparing to placebo [median HR, 95% credibility intervals: 0.16, 0.01-0.82], betablockers (0.20, 0.02-0.98), CCBs (0.21, 0.02-0.97) and ARBs (0.18, 0.02-0.91). In included trials, this combination was the treatment that most consistently achieved both lower systolic and diastolic end of study blood pressure.
There is no benefit of a single antihypertensive class in reduction of mortality in hypertensive patients with type 2 diabetes. Reduction of cardiovascular mortality observed in patients treated with ACEi and CCB combination may be related to lower blood pressure levels.
本研究旨在评估抗高血压药物类别对2型糖尿病患者死亡率的影响。
检索MEDLINE、EMBASE、临床试验和Cochrane图书馆，以查找比较噻嗪类、β受体阻滞剂、钙通道阻滞剂（CCB）、血管紧张素转换酶抑制剂（ACEi）和血管紧张素受体阻滞剂（ARB）单独或联合用于2型糖尿病患者高血压治疗的随机试验。结局指标为全因死亡率和心血管死亡率。采用网状荟萃分析获得合并效应估计值。
共纳入27项研究，包括49418名参与者，全因死亡5647例，心血管死亡1306例。与其他单一抗高血压药物类别或安慰剂相比，未观察到全因死亡率或心血管死亡率存在差异。与安慰剂[中位数风险比（HR），95%可信区间：0.16，0.01 - 0.82]、β受体阻滞剂（0.20，0.02 - 0.98）、CCB（0.21，0.02 - 0.97）和ARB（0.18，0.02 - 0.91）相比，ACEi与CCB联合使用显示出降低心血管死亡率的证据。在纳入的试验中，这种联合治疗是最能持续实现较低收缩压和舒张压的治疗方法。
单一抗高血压药物类别对降低2型糖尿病高血压患者的死亡率无益处。ACEi与CCB联合治疗的患者中观察到的心血管死亡率降低可能与较低的血压水平有关。
