Intermountain Healthcare Department of Population Health Sciences University of Utah Spencer Fox Eccles School of Medicine UT Salt Lake City USA.
Institute for Health Research Kaiser Permanente Colorado CO Aurora USA.
J Am Heart Assoc. 2023 Sep 5;12(17):e030311. doi: 10.1161/JAHA.123.030311. Epub 2023 Aug 30.
BACKGROUND Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) block distinct components of the renin-angiotensin system. Whether this translates into differential effects on cardiovascular disease events remains unclear. METHODS AND RESULTS We used the ACCORD-BP (Action to Control Cardiovascular Risk in Diabetes-Blood Pressure) trial and the SPRINT (Systolic Blood Pressure Intervention Trial) to emulate target trials of new users of ARBs versus ACEIs on cardiovascular disease events (primary outcome) and death (secondary outcome). We estimated marginal cause-specific hazard ratios (HRs) and treatment-specific cumulative incidence functions with inverse probability of treatment weights. We identified 3298 new users of ARBs or ACEIs (ACCORD-BP: 374 ARB versus 884 ACEI; SPRINT: 727 ARB versus 1313 ACEI). For participants initiating ARBs versus ACEIs, the inverse probability of treatment weight rate of the primary outcome was 3.2 versus 3.5 per 100 person-years in ACCORD-BP (HR, 0.91 [95% CI, 0.63-1.31]) and 1.8 versus 2.2 per 100 person-years in SPRINT (HR, 0.81 [95% CI, 0.56-1.18]). There were no appreciable differences in pooled analyses, except that ARBs versus ACEIs were associated with a lower death rate (HR, 0.56 [95% CI, 0.37-0.85]). ARBs were associated with a lower rate of the primary outcome among subgroups of male versus female participants, non-Hispanic Black versus non-Hispanic White participants, and those randomly assigned to standard versus intensive blood pressure (: <0.01, 0.05, and <0.01, respectively). CONCLUSIONS In this secondary analysis of ACCORD-BP and SPRINT, new users of ARB- versus ACEI-based antihypertensive medication regimens experienced similar cardiovascular disease events rates, with important subgroup differences and lower rates of death overall. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01206062, NCT00000620.
血管紧张素 II 受体阻滞剂（ARB）和血管紧张素转换酶抑制剂（ACEI）阻断肾素-血管紧张素系统的不同组成部分。这是否转化为对心血管疾病事件的不同影响尚不清楚。
我们使用 ACCORD-BP（控制糖尿病心血管风险的行动-血压）试验和 SPRINT（收缩压干预试验）模拟 ARB 与 ACEI 新使用者对心血管疾病事件（主要结局）和死亡（次要结局）的目标试验。我们使用治疗的逆概率加权估计边缘因果风险比（HR）和治疗特异性累积发生率函数。我们确定了 3298 名 ARB 或 ACEI 的新使用者（ACCORD-BP：374 名 ARB 与 884 名 ACEI；SPRINT：727 名 ARB 与 1313 名 ACEI）。对于起始 ARB 与 ACEI 的参与者，ACCORD-BP 中主要结局的治疗逆概率权重率为每 100 人年 3.2 与 3.5（HR，0.91 [95%CI，0.63-1.31]），SPRINT 中为每 100 人年 1.8 与 2.2（HR，0.81 [95%CI，0.56-1.18]）。在汇总分析中没有明显差异，除了 ARB 与 ACEI 与较低的死亡率相关（HR，0.56 [95%CI，0.37-0.85]）。ARB 与男性与女性参与者、非西班牙裔黑人与非西班牙裔白人参与者以及随机分配到标准与强化血压组的参与者亚组中主要结局的发生率较低有关（：<0.01，0.05 和<0.01，分别）。
在 ACCORD-BP 和 SPRINT 的二次分析中，ARB 与 ACEI 为基础的降压药物治疗方案的新使用者经历了相似的心血管疾病事件发生率，具有重要的亚组差异和总体死亡率较低。
https://www.clinicaltrials.gov；独特标识符：NCT01206062，NCT00000620。
