Schmieder R E, Martus P, Klingbeil A
Department of Internal Medicine IV, University Erlangen-Nürnberg, Nuremberg, Germany.
JAMA. 1996 May 15;275(19):1507-13.
To determine the ability of various antihypertensive agents to reduce left ventricular hypertrophy, a strong, blood pressure-independent cardiovascular risk factor, in persons with essential hypertension.
MEDLINE, DIMDI, RINGDOC, ADES, EMBASE, and review articles through July 1995 (English-language and full articles only).
Meta-analysis of all published articles including only double-blind, randomized, controlled clinical studies with parallel-group design.
Intensive literature search and data extraction according to a prefixed scheme performed independently by 2 investigators. Reduction of left ventricular mass index after antihypertensive therapy with placebos, diuretics, beta-blockers, calcium channel blockers, or angiotensin-converting enzyme (ACE) inhibitors was the principal parameter.
Of 471 identified references describing the effects of antihypertensive drugs on left ventricular hypertrophy, only 39 clinical trials fulfilled the inclusion criteria of our study. We found that the decrease in left ventricular mass index was more marked the greater was the decline in blood pressure (systolic r=0.46, P<.001; diastolic r=0.21, P=.08) and the longer was the duration of therapy (r=0.38, P<.01). After adjustment for different durations of treatment (mean duration of treatment, 25 weeks), left ventricular mass decreased 13% with ACE inhibitors, 9% with calcium channel blockers, 6% with beta-blockers, and 7% with diuretics. There was a significant difference between drug classes (P<.01): ACE inhibitors reduced left ventricular mass more than beta-blockers (significant, P<.05) and diuretics (tendency, P=.08). Similar differences between drug classes were found with regard to effect on left ventricular wall thickness (P<.05).
The database of articles published through July 1995 is small and incomplete, and most of the articles are of poor scientific quality. In this first meta-analysis including only double-blind, randomized, controlled clinical studies, decline in blood pressure, duration of drug treatment, and drug class determined the reductions in left ventricular mass index. The ACE inhibitors seemed to be more potent than beta-blockers and diuretics in the reduction of left ventricular mass index; calcium channel blockers were somewhat in the intermediate range. The ACE inhibitors and, to a lesser extent, calcium channel blockers emerged as first-line candidates to reduce the risk associated with left ventricular hypertrophy.
确定各种抗高血压药物在原发性高血压患者中降低左心室肥厚（一种与血压无关的重要心血管危险因素）的能力。
MEDLINE、DIMDI、RINGDOC、ADES、EMBASE以及截至1995年7月的综述文章（仅英文全文）。
对所有已发表文章进行荟萃分析，仅纳入采用平行组设计的双盲、随机、对照临床研究。
由2名研究人员根据预先设定的方案独立进行深入的文献检索和数据提取。抗高血压治疗（使用安慰剂、利尿剂、β受体阻滞剂、钙通道阻滞剂或血管紧张素转换酶（ACE）抑制剂）后左心室质量指数的降低是主要参数。
在471篇描述抗高血压药物对左心室肥厚影响的参考文献中，只有39项临床试验符合我们研究的纳入标准。我们发现，血压下降幅度越大（收缩压r = 0.46，P <.001；舒张压r = 0.21，P =.08）以及治疗持续时间越长（r = 0.38，P <.01），左心室质量指数的下降就越明显。在对不同治疗持续时间（平均治疗持续时间为25周）进行调整后，ACE抑制剂使左心室质量下降13%，钙通道阻滞剂使左心室质量下降9%，β受体阻滞剂使左心室质量下降6%，利尿剂使左心室质量下降7%。药物类别之间存在显著差异（P <.01）：ACE抑制剂降低左心室质量的效果优于β受体阻滞剂（P <.05，差异显著）和利尿剂（P =.08，有趋势性差异）。在对左心室壁厚度的影响方面，药物类别之间也发现了类似差异（P <.05）。
截至1995年7月发表文章的数据库规模小且不完整，并且大多数文章的科学质量较差。在这项仅纳入双盲、随机、对照临床研究的首次荟萃分析中,血压下降、药物治疗持续时间和药物类别决定了左心室质量指数的降低。在降低左心室质量指数方面，ACE抑制剂似乎比β受体阻滞剂和利尿剂更有效；钙通道阻滞剂的效果处于中间范围。ACE抑制剂以及在较小程度上钙通道阻滞剂成为降低与左心室肥厚相关风险的一线候选药物。
