Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan.
Hypertens Res. 2019 May;42(5):669-680. doi: 10.1038/s41440-019-0234-6. Epub 2019 Apr 5.
Renin-angiotensin system (RAS) inhibitors are often used as a first-line treatment for hypertensive patients with diabetes because of purported benefits, such as reno-protection. However, there is no clear evidence for the superiority of RAS inhibitors to other classes of antihypertensives for clinically important outcomes in this population. We conducted a meta-analysis to assess whether RAS inhibitors are better than other classes of antihypertensives for reducing mortality, and cardiovascular and renal events in hypertensive patients with diabetes. From June to December 2017, we searched Medline, Cochrane Library, and the database of the Japan Medical Abstracts Society (ICHUSHI) for relevant published randomized controlled trials that directly compared the effects of RAS inhibitors to other classes of antihypertensives as first-line treatments for reducing adverse outcomes among hypertensive patients with diabetes. Our predetermined outcomes included all-cause death, cardiovascular death, incidence of cardiovascular disease, and renal dysfunction. We identified 16 trials, including a total of 35,052 patients. No significant benefits for RAS inhibitors were found compared to other classes of antihypertensives for all-cause death (relative risk (RR) 0.95, 95% confidence interval (CI) 0.85-1.05, p = 0.29), cardiovascular death (RR 0.84, 95% CI 0.68-1.04, p = 0.11), incidence of cardiovascular disease (RR 0.93, 95% CI 0.84-1.03, p = 0.16), and incidence of renal dysfunction (RR 0.91, 95% CI 0.77-1.06, p = 0.22). In conclusion, RAS inhibitors are not superior to other classes of antihypertensive drugs for reducing all-cause and cardiovascular mortalities, cardiovascular events, and renal events in hypertensive patients with diabetes.
肾素-血管紧张素系统（RAS）抑制剂常被用作糖尿病高血压患者的一线治疗药物，因为据称其具有肾保护作用等益处。然而，对于此类患者的临床重要结局，并无确切证据表明 RAS 抑制剂优于其他降压药物类别。我们进行了一项荟萃分析，以评估 RAS 抑制剂是否优于其他降压药物类别，从而降低糖尿病高血压患者的死亡率和心血管及肾脏事件。我们于 2017 年 6 月至 12 月，检索了 Medline、Cochrane 图书馆和日本医学文摘学会（ICHUSHI）数据库，以查找直接比较 RAS 抑制剂与其他降压药物类别作为一线治疗药物，从而降低糖尿病高血压患者不良结局的相关已发表的随机对照试验。我们预先设定的结局包括全因死亡、心血管死亡、心血管疾病发生率和肾功能障碍。我们共确定了 16 项试验，共计 35052 例患者。与其他降压药物类别相比，RAS 抑制剂并未显示出对全因死亡（相对风险（RR）0.95，95%置信区间（CI）0.85-1.05，p=0.29）、心血管死亡（RR 0.84，95% CI 0.68-1.04，p=0.11）、心血管疾病发生率（RR 0.93，95% CI 0.84-1.03，p=0.16）和肾功能障碍发生率（RR 0.91，95% CI 0.77-1.06，p=0.22）的有益作用。总之，对于糖尿病高血压患者，RAS 抑制剂并不优于其他降压药物类别，无法降低全因和心血管死亡率、心血管事件和肾脏事件。
