American Society of Hypertension (ASH) 2009 Scientific Meeting reported that：ARB似乎是最贵的一类降压药了，药名大多是**沙坦之类。到现在为止，笔者的医院还没有这类药供使用。之前映象中，ARB一直是比较受推荐的降压 药，现在看到这篇文章，真是不知说什么好了。不过医学上这种事情也经常发生，一个药在几年前是毒药，说不定几年后就成了救命仙丹。笔者习惯上喜欢依那普利 和硝苯地平联合的方案似乎在目前的认识里还是一个不错的方案。
Most Hypertension Drugs, Except ARBs, Better Than No Treatment for CHD Risk Reduction.
2009美国高血压协会年会上报道:
Most Hypertension Drugs, Except ARBs, Better Than No Treatment for CHD Risk Reduction
除了ARB类,大多数高血压药物都可降低冠心病风险
Michael O'Riordan
May 7, 2009 (San Francisco, California) — Two large analyses estimating the cardiovascular and stroke benefit with initial drug treatment for hypertension showed that only angiotensin receptor blockers (ARBs) were not significantly better than placebo for the prevention of coronary events, while all antihypertensive drugs were better than placebo for the prevention of stroke.
2009年5月7日(旧金山,加利福尼亚)-2个大型的关于起始降压药物治疗对心血管和卒中益处的分析显示, 只有血管紧张素受体抑制剂 (ARB)类对冠心病的预防与安慰剂相似; 所有抗高血压药物对卒中的预防均优于安慰剂
Dr William Elliott
Regarding the lack of cardiovascular protection with ARBs, investigators suggest that this is the result of a limited number of studies and cardiovascular outcomes in these trials compared with the other drug classes.
对于ARB类并没有显示出对心血管的保护作用, 研究者指出, 这是由于与其它类抗高血压药物相比,ARB类试验的研究数量和心血管方面的结 果都有限造成的.
"People should feel very comfortable that when their doctor is giving them a certain medication they don't have to worry," said lead investigator Dr William Elliott (Rush Medical College, Chicago, IL). "The concern we have with the ARBs is probably because we simply don't have enough data at this time. . . . There really aren't enough data with ARBs to make a really strong statement."
"如果医生处方某一药物,患者无须担心", 主要研究者Willianm Elliott医生(Rush医学院,芝加哥,伊利诺斯州), "我们对ARB类药物的担心可能仅仅是因为目前有关这类药物的数据并不是非常充足…….. 而我们也的确没有足够的证据来对ARB类药物下一个明确的结论"
The two meta-analyses were presented here this week at the American Society of Hypertension (ASH) 2009 Scientific Meeting.
这两个荟萃分析的结果是在本周的美国高血压协会年会上公布的.
Meta-Analysis Includes Recent Hypertension Trials
荟萃分析包括了近期有关高血压的试验.
During a press conference with assembled media, Elliott said that the last meta-analysis estimating outcomes with initial hypertensive therapy was performed in 2003, before the publication of Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). In that analysis, researchers concluded there was a reduction in stroke with any hypertensive drug but that low-dose diuretics were the most effective first-line agents for preventing cardiovascular disease.
在对媒体的新闻发布会上, Elliott说, 在此之前, 最后一个评价起始高血压药物治疗的荟萃分析是在2003年, 在JNC 7发布之前. 在那次分析中,研究者得到的结论是,所有的抗高血压药物均可以降低卒中的发生,但是小剂量利尿剂是最有效的预防心血管疾病的一线治疗药物
However, with the publication of the Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH), a study showing the ACE inhibitor benazepril plus the calcium-channel blocker amlodipine was more effective than treatment with the ACE inhibitor and diuretic in reducing major fatal and nonfatal cardiovascular events, there is some uncertainty if this is still true, said Elliott.
然而, ACCOMPLISH试验的结果显示,ACEI类药物贝那普利与CCB类药物氨氯地平联用可有效减少致命或非致命的性心血管事件的发 生, 疗效显著优于贝那普利与利尿剂联用. 当然,这个结果是否仍然确实还不确定, Elliott说.
In the two new meta-analyses, investigators included all published outcomes-based clinical trials with minimum follow-up of one year. All subjects included in the analysis were required to have hypertension, thereby excluding studies such as HOPE, PROGRESS, EUROPA, PEACE, and ONTARGET, among others, and the drug used must have been prescribed as initial antihypertensive therapy. The reference drug in the two analyses was diuretic therapy.
在这两个新的荟萃分析中,研究者纳入了所有随访时间超过一年的以终点事件为基础的 临床试验. 分析中所有的入组患者必须患有高血压, 因此除外了HOPE, PROGRESS, EUROPA, PEACE和ONTARGET等试验. 另外, 所有使用的抗高血压药物必须是抗高血压的起始治疗. 在这两个荟萃分析中,对照药物是利尿剂.
In an analysis estimating the reduction in stroke risk with the hypertensive medications, which included nearly 270 000 hypertensive patients in 60 clinical trials, all medications were significantly better than placebo for reducing the risk of stroke. Diuretics and calcium-channel blockers were slightly more protective than ARBs but were significantly better than ACE inhibitors and beta blockers.
在评价抗高血压药物降低卒中风险的分析中,纳入了60个临床研究中的270000高血压患者. 分析结果显示所有抗高血压药物降低卒中的危险均优于安慰剂. 利尿剂和钙通道拮抗剂略优于ARB类,且显著优于ACEI类和β受体阻滞剂.
Network Meta-Analysis: Risk of Stroke
网络荟萃分析(计算机荟萃分析): 卒中的风险
Treatment Odds ratio (95% CI)
治疗比数比 (95%可信区间)
Placebo 1.56 (1.44–1.77)
安慰剂 1.56(1.44-1.77)
Beta blockers 1.22 (1.11–1.35)
β受体阻滞剂 1.22(1.11-1.35)
ACE inhibitor 1.17 (1.07–1.29)
ACEI 1.17(1.07-1.29)
Angiotensin receptor blocker 1.10 (0.96–1.26)
ARB 1.10(0.96-1.26)
Calcium-channel blocker 1.00 (0.92–1.10)
钙通道拮抗剂 1.00(0.92-1.10)
Diuretic Reference
利尿剂对照
Investigators noted that the results were identical whether the reference diuretic was chlorthalidone or hydrochlorothiazide and that the overall network findings were confirmed by Bayesian analysis. Moreover, the data are robust to numerous changes in the data set, which included the addition of ACCOMPLISH to the analysis as well as different studies that included add-on drug therapy for the treatment of hypertension and studies that didn't include patients with high blood pressure.
研究者指出, 无论对照的利尿剂是氯噻酮还是氢氯噻嗪结果都是一样的.所有的分析结果均来自贝叶斯分析(通过比较A和B，B和C的试验，得出A和C的比较). 而且，即使数据库中的数据发生变化，结果都是相似的。这些变化包括加入ACCOMPLISH研究，也包括 加入一些不同的研究，比如高血压的加药治疗研究和患者无高血压的研究。
"The fact is that it doesn't really matter when you add in these other studies, you get the same answer," said Elliott.
"实际上，即使加入其它的试验进行分析，结果是一样的。"Elliott说。
Cardiovascular Risk Reduction With Antihypertensive Drugs
抗高血压药物减少心血管风险
In the second meta-analysis examining coronary heart disease risk reduction with the different antihypertensive drugs, the researchers used the same entry criteria and included 57 clinical trials involving 276 000 patients. In that analysis, all drugs, except ARBs, were significantly better than placebo or no treatment for reducing the risk of coronary events.
在第二个评价不同抗高血压药物降低冠心病风险的荟萃分析中，研究者使用同样的入选标准，纳入了57个临床试验的 276000例患者。在分析中，除了ARB类药物，所有抗高血压药物均较安慰剂或无治疗显著降低冠心病风险。
"The good news is that all of the generically available medicines are significantly better than placebo, and the take-home message for patients and doctors is that you can be sure whatever generic medicine you're taking does protect you better than placebo or no treatment for heart attack and sudden cardiac death," said Elliott.
"好消息是，所有种类的药物均优于安慰剂。对医生和患者来说，最重要的信息是无论使用哪种抗高血压药物，均可降低心脏病发作和突发心脏病死亡，" Elliott说。
The findings also showed that ACE inhibitors were significantly better than ARBs and beta blockers for coronary heart disease risk reduction, which echoes previous reports suggesting ACE inhibitors have pleiotropic effects independent from blood-pressure lowering that protect patients from cardiovascular events.
结果同时也显示,ACEI在降低冠心病风险方面明显优于ARB类和β受体阻滞剂,这一结果反映了之前关于ACEI的报道,即ACEI的多效性 是独立于其降压作用之外的,因此可以降低患者的心血管风险.
Like the stroke findings, the results were similar when different studies were added to the analysis and when the different diuretics were used as the reference drugs.
Speaking with the media, Elliott noted that the results have been heralded as a "tempest in a teapot" because most patients with hypertension are treated with multiple antihypertensive drugs, whereas this analysis was concerned primarily with looking at risk reduction with initial hypertension therapy. However, since treatment in the US follows "road maps," and patients are typically started with one drug, it is important to know the differences with the different pathways that lead to getting blood pressure down, he said.
与 卒中的结果相似,当增加了不同的研究以及无论使用何种利尿剂作对照,结果都是一样的. Elliott对媒体说,这一结果被认为有些小题大做, 因为很多高血压患者是接受联合治疗的,而该分析着重于高血压起始药物治疗对危险的影响. 但是,因为在美国, 高血压的治疗遵循一定的流程, 很多患者通常起始使用单药治疗,因此了解起始不同治疗之间的差异是很重要的,他说.
Elliott reports serving as a consultant to Novartis Pharmaceuticals and is on the speakers' bureau for Novartis, Pfizer, a Bristol Myers-Squibb/Sanofi-Synthelabo partnership, and Sanofi-Aventis.
Elliott 声明,他是诺华制药的专家顾问,并任诺华,辉瑞,和赛诺菲的讲者.
Authors and Disclosures
作者和声明
Journalist
记者
Michael O'Riordan
Michael O'Riordan is a journalist for Medscape. Before becoming a journalist for theheart.org, now part of the WebMD Professional Network, he worked for WebMD Canada. Michael studied at Queen's University in Kingston and the University of Toronto and has a master's degree in journalism from the University of British Columbia, where he specialized in medical reporting. He can be contacted at MORiordan@webmd.net.
Michael O'Riordan是Medscape的记者.在成为theheart.org(现为WebMD 专业网络的一部分)记者之前,他工作于加拿大的WebMD. Michael曾就读于Kingston的女皇大学和多伦多大学,并于英属哥伦比亚大学获得新闻学硕士学位,致力于医学报道.他的联系方 式：MORiordan@webmd.net.
2009年5月12日星期二
医院：血管紧张素受体拮抗剂(ARBs)对于冠心病的预防没有显着优于安慰剂
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