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首页> 外文期刊>Annals of Internal Medicine >Systematic Review: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers for Treating Essential Hypertension
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Systematic Review: Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers for Treating Essential Hypertension

机译：系统评价：血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂治疗原发性高血压的比较效果

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Background: The relative effectiveness of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) for lowering blood pressure is unknown. nnPurpose: To compare the benefits and harms of ACE inhibitors versus ARBs for treating essential hypertension in adults. nnData Sources: MEDLINE (1966 to May 2006), the Cochrane Central Register of Controlled Trials (Issue 2, 2006), and selected reference lists were searched for relevant English-language trials. The MEDLINE search was updated to August 2007 to identify head-to-head trials that reported blood pressure outcomes and major cardiovascular events. nnStudy Selection: 61 clinical studies that directly compared ACE inhibitors versus ARBs in adult patients with essential hypertension, reported an outcome of interest, lasted at least 12 weeks, and included at least 20 patients. nnData Extraction: A standardized protocol with predefined criteria was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality and applicability; and assess the strength of the body of evidence for key outcomes. nnData Synthesis: ACE inhibitors and ARBs had similar long-term effects on blood pressure (50 studies; strength of evidence, high). No consistent differential effects were observed for other outcomes (few studies reported long-term outcomes), including death, cardiovascular events, quality of life, rate of single antihypertensive agent use, lipid levels, progression to diabetes, left ventricular mass or function, and kidney disease. Consistent fair- to good-quality evidence showed that ACE inhibitors were associated with a greater risk for cough. There were fewer withdrawals due to adverse events and greater persistence with therapy for ARBs than for ACE inhibitors, although this evidence was not definitive. Patient subgroups for whom ACE inhibitors or ARBs were more effective, associated with fewer adverse events, or better tolerated were not identified. nnLimitations: Few studies involved a representative sample treated in a typical clinical setting over a long duration, treatment protocols had marked heterogeneity, and substantive amounts of data about important outcomes and patient subgroups were missing. nnConclusion: Available evidence shows that ACE inhibitors and ARBs have similar effects on blood pressure control, and that ACE inhibitors have higher rates of cough than ARBs. Data regarding other outcomes are limited.
机译：背景：血管紧张素转换酶（ACE）抑制剂和血管紧张素II受体阻滞剂（ARB）降低血压的相对有效性尚不清楚。目的：比较ACE抑制剂和ARB在治疗成人原发性高血压中的利弊。 nn数据来源：MEDLINE（1966年至2006年5月），Cochrane对照试验中央登记册（2006年第2期），并从选定的参考清单中搜索了相关的英语试验。 MEDLINE搜索已更新至2007年8月，以鉴定报告血压结果和主要心血管事件的头对头试验。 nn研究选择：61项临床研究直接比较了成人原发性高血压患者中ACEI抑制剂与ARB的关系，报告了有意义的结果，持续至少12周，包括至少20名患者。 nn数据提取：使用具有预定义标准的标准化协议来提取有关研究设计，干预措施，人群特征和结果的数据；评估研究质量和适用性；并评估关键结果证据的强度。 nn数据综合：ACE抑制剂和ARB对血压具有类似的长期影响（50项研究；证据强度很高）。在其他结局（几乎没有研究报告长期结局），包括死亡，心血管事件，生活质量，单一降压药使用率，脂质水平，糖尿病进展，左心室质量或功能以及肾脏疾病。始终如一的优质证据表明，ACEI与咳嗽的风险更高。与ACEI抑制剂相比，ARBs的不良事件和持久性使退出治疗的人数减少，尽管这一证据尚不确定。没有发现ACE抑制剂或ARB更有效，不良事件更少或耐受性更好的患者亚组。局限性：很少有研究涉及在典型的临床环境中长期治疗的代表性样本，治疗方案具有明显的异质性，并且缺少有关重要结局和患者亚组的大量数据。 nn结论：现有证据表明ACE抑制剂和ARB对血压控制的作用相似，并且ACE抑制剂的咳嗽率高于ARB。关于其他结果的数据有限。

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