Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
J Hum Hypertens. 2018 Jul;32(7):494-506. doi: 10.1038/s41371-018-0066-x. Epub 2018 May 1.
First-line renin-angiotensin system (RAS) inhibitors are recommended for diabetic patients because of their potential nephron-protective properties. For hypertensive patients with type 2 diabetes mellitus, little is known about first-line RAS inhibitors vs. other first-line antihypertensive agents in terms of cardiovascular outcomes. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the comparative efficacy of first-line RAS inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus. We identified RCTs by searching the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE up to December 15, 2015. Eighteen RCTs involving 18,862 participants were included. First-line RAS inhibitors were not different from first-line diuretics for all the primary outcomes. First-line RAS inhibitors reduced major cardiovascular events (2 RCTs, relative risk [RR] 0.78, 95% confidence interval [CI] 0.66, 0.91) and heart failure (4 RCTs, RR 0.72, 95% CI 0.61, 0.83) compared to first-line calcium channel blockers. Compared to β-blockers, RAS inhibitors reduced the risk of all-cause mortality (1 RCT, RR 0.63, 95% CI 0.47, 0.84), major cardiovascular events (1 RCT, RR 0.76, 95% CI 0.62, 0.93) and heart failure (1 RCT, RR 0.60, 95% CI 0.40, 0.92). Our meta-analysis indicates that, in patients with type 2 diabetes mellitus and hypertension, first-line RAS inhibitors reduced adverse cardiovascular events to the same degree as first-line diuretics but to a greater degree than first-line calcium channel blockers and first-line beta blockers.
一线肾素-血管紧张素系统（RAS）抑制剂因其潜在的肾保护特性而被推荐用于糖尿病患者。对于患有 2 型糖尿病的高血压患者，关于一线 RAS 抑制剂与其他一线抗高血压药物在心血管结局方面的比较效果知之甚少。我们进行了一项荟萃分析，以评估一线 RAS 抑制剂与 2 型糖尿病高血压患者的其他一线降压药物类别相比的疗效。我们通过搜索 Cochrane 对照试验中央注册库、MEDLINE 和 EMBASE 来确定随机对照试验（RCT），截至 2015 年 12 月 15 日。共纳入了 18 项涉及 18862 名参与者的 RCT。一线 RAS 抑制剂与一线利尿剂在所有主要结局方面没有差异。与一线钙通道阻滞剂相比，一线 RAS 抑制剂降低了主要心血管事件（2 项 RCT，相对风险 [RR] 0.78，95%置信区间 [CI] 0.66，0.91）和心力衰竭（4 项 RCT，RR 0.72，95% CI 0.61，0.83）。与β受体阻滞剂相比，RAS 抑制剂降低了全因死亡率（1 项 RCT，RR 0.63，95% CI 0.47，0.84）、主要心血管事件（1 项 RCT，RR 0.76，95% CI 0.62，0.93）和心力衰竭（1 项 RCT，RR 0.60，95% CI 0.40，0.92）的风险。我们的荟萃分析表明，在患有 2 型糖尿病和高血压的患者中，一线 RAS 抑制剂降低不良心血管事件的程度与一线利尿剂相同，但程度大于一线钙通道阻滞剂和一线β受体阻滞剂。
