Dr.Jeong's Heart Clinic, Jeonju, Republic of Korea.
Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea.
Sci Rep. 2021 Jan 19;11(1):1783. doi: 10.1038/s41598-021-81373-7.
Although both angiotensin receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs) are all suitable for the initiation of antihypertensive treatment, studies investigating efficacy and safety between ARBs and CCBs are limited, and there is no previous study comparing their clinical outcomes during long-term follow-up periods in real world setting. We compared cardiovascular (CV) events between ARBs and CCBs in 464,948 hypertensive adults using the Korean National Health Insurance Service database during a 3-year follow-up. The patients with hypertension without heart failure, ischemic heart disease, cerebrovascular disease, or peripheral artery disease were enrolled. The CV events between only single prescription of CCBs and ARBs were finally compared. The primary endpoint for this study was the first occurrence of a major adverse CV events, defined as the composite of all-cause death, cardiac death, nonfatal myocardial infarction, or nonfatal stroke. ARB was significantly more administered in male and patients with higher income, diabetes mellitus, chronic kidney diseases, and higher Charlson comorbidity index. The primary endpoints occurred in 10,526 patients (5.2%) in the ARB group and in 19,363 patients (7.3%) in the CCB group (p < 0.001) during a 3-year follow-up (HR 0.96, 95% CI 0.93-0.98). All the components of CV events including all-cause death, cardiac death, nonfatal myocardial infarction, and nonfatal stroke occurred more frequently in the CCB group. With multivariable models adjusting age, sex, income, diabetes, chronic kidney disease, and Charlson comorbidity index, the primary endpoints less frequently developed in the ARB group than in the CCB group (HR 0.957, 95% CI 0.933-0.983, p < 0.001). After the propensity-score matching, baseline characteristics were similar and still showed significantly better primary endpoints in ARB group than CCB group (5.3% vs. 5.8%, p < 0.001). In this nationwide population-based simple hypertension study, administration of ARBs showed superior protection against CV events than CCBs during a 3-year follow-up. Our results suggest that ARBs could be preferred over CCBs as the initial choice of antihypertensive treatment regardless of age in real-world practice.
虽然血管紧张素受体阻滞剂 (ARBs) 和二氢吡啶类钙通道阻滞剂 (CCBs) 均适用于起始降压治疗，但 ARBs 和 CCBs 之间的疗效和安全性研究有限，并且在真实世界环境下，没有之前的研究比较它们在长期随访期间的临床结局。我们使用韩国国家健康保险服务数据库，在 3 年的随访期间，比较了 464948 例高血压成年人中 ARBs 和 CCBs 之间的心血管 (CV) 事件。纳入了无心力衰竭、缺血性心脏病、脑血管病或外周动脉疾病的高血压患者。最终比较了仅单一处方 CCBs 和 ARBs 的 CV 事件。本研究的主要终点是首次发生主要不良 CV 事件，定义为全因死亡、心脏死亡、非致死性心肌梗死或非致死性卒中的复合终点。ARB 在男性和收入较高、糖尿病、慢性肾脏病和 Charlson 合并症指数较高的患者中使用更为广泛。ARB 组的主要终点事件发生在 10526 例患者（5.2%）中，CCB 组发生在 19363 例患者（7.3%）中（p<0.001），随访时间为 3 年（HR 0.96，95%CI 0.93-0.98）。所有 CV 事件的组成部分，包括全因死亡、心脏死亡、非致死性心肌梗死和非致死性卒中，在 CCB 组更为常见。在调整年龄、性别、收入、糖尿病、慢性肾脏病和 Charlson 合并症指数的多变量模型中，ARB 组的主要终点事件发生率低于 CCB 组（HR 0.957，95%CI 0.933-0.983，p<0.001）。在倾向评分匹配后，基线特征相似，ARB 组的主要终点仍明显优于 CCB 组（5.3% vs. 5.8%，p<0.001）。在这项基于全国人群的单纯性高血压研究中，在 3 年的随访期间，ARB 的应用显示出对 CV 事件的保护作用优于 CCBs。我们的结果表明，在真实世界实践中，无论年龄大小，ARB 都可作为降压治疗的初始选择，优于 CCBs。
