Mulrow C D, Mulrow J P, Linn W D, Aguilar C, Ramirez G
Division of General Internal Medicine, University of Texas Health Science Center, San Antonio.
JAMA. 1988 Jun 17;259(23):3422-6.
We examined existing evidence concerning the relative efficacy of various vasodilator agents in chronic congestive heart failure. Only randomized placebo-controlled trials with clinical end points and treatment durations of four weeks or more were selected from an exhaustive search of the English-language medical literature. Twenty-eight trials involving 1976 patients were found. Treatment durations of the trials varied from one month to two years. Patients with symptomatic heart failure despite digitalis and diuretic therapy were studied; most were middle-aged men and approximately half had coronary artery disease. Results of the trials were appraised by three independent observers, and mortality and functional status outcomes were pooled in a meta-analysis. All vasodilator agents except hydralazine hydrochloride were associated with improvements in functional status. Angiotensin converting-enzyme inhibitors were the only agents associated with both decreased mortality (odds ratio, 0.51; 95% confidence interval, 0.34 to 0.75) and improved functional status (odds ratio, 4.53; 95% confidence interval, 3.46 to 5.92). The optimal timing for initiation of these agents was not established.
我们研究了有关各种血管扩张剂在慢性充血性心力衰竭中相对疗效的现有证据。从对英文医学文献的详尽检索中，仅选取了具有临床终点且治疗持续时间为四周或更长时间的随机安慰剂对照试验。共找到28项涉及1976例患者的试验。试验的治疗持续时间从1个月到2年不等。研究对象为尽管接受了洋地黄和利尿剂治疗仍有症状性心力衰竭的患者；大多数为中年男性，约一半患有冠状动脉疾病。试验结果由三名独立观察者进行评估，并将死亡率和功能状态结果汇总进行荟萃分析。除盐酸肼屈嗪外，所有血管扩张剂均与功能状态改善相关。血管紧张素转换酶抑制剂是唯一与死亡率降低（优势比，0.51；95%置信区间，0.34至0.75）和功能状态改善（优势比，4.53；95%置信区间，3.46至5.92）均相关的药物。启动这些药物的最佳时机尚未确定。
