Schmieder R E, Schlaich M P, Klingbeil A U, Martus P
Department of Medicine IV, University of Erlangen-Nürnberg, Nürnberg, Germany.
Nephrol Dial Transplant. 1998 Mar;13(3):564-9. doi: 10.1093/ndt/13.3.564.
To provide an update on the ability of different antihypertensive drugs to reduce left ventricular hypertrophy in essential hypertension.
Relevant medical databases including MEDLINE, BIOSIS PREVIEWS, EMBASE, and SCISEARCH as well as review articles to December 1996.
Meta-analysis of all published articles including only double-blind, randomized, controlled clinical studies with parallel-group design.
Literature search and data extraction according to a prefixed scheme performed independently by two investigators. The primary parameter was reduction of left ventricular mass by antihypertensive therapy with placebo, diuretics, beta-blockers, calcium channel blockers, or ACE-inhibitors.
Fifty studies published till the end of December 1996 were identified. They comprised a total of 1715 patients in 13 placebo (n=165, age: 50+/-3 years) and 89 active treatment arms (n=1550, age: 56+/-10 years) respectively. Overall, for active treatment left ventricular mass index was the more reduced the greater the decrease in systolic blood pressure, (r=0.27; P<0.05), the longer the duration of therapy (r=0.36; P<0.001), and the higher the pretreatment value of left ventricular mass index (r= 0.53; P<0.001). Left ventricular mass index was decreased by 12% with ACE-inhibitors (95% CI: 9.0-14.5%), by 11% with calcium channel blockers (95% CI: 7.8-13.7%), by 5% with beta-blockers (95% CI: 1.2-7.3%) and by 8% with diuretics (95% CI: 3.9-11.1%) (overall P<0.01). Subsequent tests revealed that ACE-inhibitors and calcium channel blockers were more effective than beta-blockers in reducing left ventricular mass index (P<0.05). Similar differences between drug classes were found with regard to effect on left ventricular wall thickness (P<0.05).
Decrease in systolic blood pressure, duration of antihypertensive therapy, degree of pretreatment left ventricular hypertrophy and antihypertensive drug class determined the reduction of left ventricular hypertrophy. ACE-inhibitors and calcium channel blockers were more potent in reducing left ventricular mass than beta-blockers, with diuretics in the intermediate range.
提供不同抗高血压药物降低原发性高血压患者左心室肥厚能力的最新信息。
相关医学数据库，包括MEDLINE、BIOSIS PREVIEWS、EMBASE和SCISEARCH，以及截至1996年12月的综述文章。
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。
由两名研究人员根据预先设定的方案独立进行文献检索和资料提取。主要参数是使用安慰剂、利尿剂、β受体阻滞剂、钙通道阻滞剂或血管紧张素转换酶抑制剂进行抗高血压治疗后左心室质量的降低情况。
共确定了截至1996年12月底发表的50项研究。这些研究分别包括13个安慰剂组（n = 165，年龄：50±3岁）和89个活性治疗组（n = 1550，年龄：56±10岁）的1715名患者。总体而言，对于活性治疗，收缩压下降幅度越大，左心室质量指数降低越多（r = 0.27；P < 0.05），治疗持续时间越长，左心室质量指数降低越多（r = 0.36；P < 0.001），左心室质量指数的预处理值越高，左心室质量指数降低越多（r = 0.53；P < 0.001）。血管紧张素转换酶抑制剂使左心室质量指数降低12%（95%可信区间：9.0 - 14.5%），钙通道阻滞剂使左心室质量指数降低11%（95%可信区间：7.8 - 13.7%），β受体阻滞剂使左心室质量指数降低5%（95%可信区间：1.2 - 7.3%），利尿剂使左心室质量指数降低8%（95%可信区间：3.9 - 11.1%）（总体P < 0.01）。后续试验表明，血管紧张素转换酶抑制剂和钙通道阻滞剂在降低左心室质量指数方面比β受体阻滞剂更有效（P < 0.05）。在对左心室壁厚度的影响方面，不同药物类别之间也发现了类似差异（P < 0.05）。
收缩压降低、抗高血压治疗持续时间、预处理左心室肥厚程度和抗高血压药物类别决定了左心室肥厚的降低情况。血管紧张素转换酶抑制剂和钙通道阻滞剂在降低左心室质量方面比β受体阻滞剂更有效，利尿剂的效果处于中间范围。
