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1、最新最新RASRAS抑制剂荟萃分析结果抑制剂荟萃分析结果-Eur heart J. 2012.Apr.17 -Eur heart J. 2012.Apr.17 This meta-analysis included almost 160 000 patients from 20 randomized, controlled morbidity-mortality trials （20002011） that met the inclusion criteria. Mean follow-up was 4.3 years and 91% of the patients were hyperten
2、sive. Editorial: Only ACE inhibitors improve the survival of hypertensive patientsEditorial: Only ACE inhibitors improve the survival of hypertensive patients Michel E. Bertrand. Cardiotime. May 7, 2012 In 2012, hypertension remains a major public health care issue. According to the World Health Org
3、anization, one-third of the European population has abnormal blood pressure. Of the total US population, 25% has hypertension, ie, 65 million Americans. With todays increased life expectancy, it is evident that the prevalence of hypertension increases with advancing age: more than 50% of individuals
4、 between 60 and 69 years and 75% of those older than 70 years of age have abnormal blood pressure. Overall, hypertension is responsible for more than 7 million deaths worldwide and for a large number of cerebrovascular accidents and myocardial infarction.The European guidelines on hypertension (2007
5、),1 as well as the British guidelines (2011),2 clearly defined the primary goal of hypertension treatment as long-term reduction of mortality and morbidity. It is well accepted that modern antihypertensive treatment reduces the risk of stroke, myocardial infarction, and heart failure; nevertheless,
6、the guidelines point out that the impact on mortality is still questionable. This matter has been resolved in a recent paper published in the European Heart Journal concerning a meta-analysis of data collected in clinical trials considering the impact of modern antihypertensive therapy on the surviv
7、al of hypertensive patients.3 The methodology was very strict: trials were identified from data published from January 1, 2000 to March 1, 2011 on the basis that more than 66% of the population was hypertensive. Trials selecting patients with a specific disease, such as acute coronary syndrome or ac
8、ute stroke, or post-cardiac surgery patients, were excluded. Of 44 trials that were initially identified, 8 were excluded because less than two-thirds (66.7%) of the individuals had hypertension. Another 16 trials were excluded for various reasons (low number of patients n100, all-cause mortality no
9、t reported, simultaneous use of the same drugs in both trial arms).Finally, the meta-analysis was based on 20 trials and a cohort of 158 998 patients, of whom 91% were hypertensive. Angiotensin-converting enzyme (ACE) inhibitors were used as the active treatment in 7 trials (n=76 615). In 13 trials,
10、 angiotensin receptor blocker (ARB) was the active treatment (n=82 383).During a mean follow-up of 4.3 years, 8.8% of patients assigned to renin-angiotensin-aldosterone-system (RAAS) inhibitors died, compared with 10% in the control group. It was demonstrated that treatment of hypertension with RAAS
11、 inhibitors was associated with a statistically significant 5% reduction in all-cause mortality (hazard ratio HR 0.95; 95% confidence interval CI, 0.91-1.00; P=0.032). It is important to note that ACE inhibitors were associated with a statistically significant 10% mortality reduction: (HR 0.90; 95%
12、CI, 0.84-0.97; P=0.004). However, no significant mortality reduction was observed with ARB treatment (HR 0.99; 95% CI, 0.94-1.04; P=0.683). This latter observation confirms results from an analysis by Bangalore et al4 showing the lack of impact on all-cause mortality with ARBs. This difference in tr
13、eatment effects between ACE inhibitors and ARBs was statistically significant ( P value for interaction, 0.036). Interestingly, analysis of mortality reduction by different ACE inhibitors showed that perindopril-based regimens were associated with a statistically significant 13% all-cause mortality
14、reduction.This meta-analysis confirms that ACE inhibitors are pivotal and certainly the first-line choice in hypertension treatment. In past years, clinicians advising hypertensive patients to better control their elevated blood pressure mentioned that this was mainly to prevent occurrence of stroke, heart failure, or coronary events. Now, it is evident that treatment of hypertension also improves survival. Taking into account the broad spectrum of the hypertensive population, one might expect that an effective treatment with ACE inhibitors would result in an important gain of lives saved.
