卒中是美國人死亡的第二主要死因(編者注：在中國是第一死因)，卒中獨立危險因素——藥物治療高血壓可顯著降低卒中發生率。雖然既往薈萃研究顯示，在減少卒中風險方麵，不同種類的抗高血壓藥優於安慰劑，但哪種最有效尚不明。美國學者們對此進行了薈萃分析，結果表明，在所有抗高血壓藥物中，鈣離子通道阻滯劑(CCB)在長期減少卒中發生方麵最有效，而β受體阻滯劑與這種風險增加顯著相關。
研究者們係統檢索了在1999至2014年發表的有關抗高血壓治療對卒中一級和或二級預防的隨機對照臨床試驗(RCT)，對比了五類降壓藥的效果，這五類藥物包括血管緊張素轉換酶抑製劑(ACEI)、血管緊張素受體拮抗劑(ARB)、β受體阻滯劑、鈣離子通道阻滯劑(CCB)和噻嗪樣利尿劑(T-T LD)。
結果共納入251853例患者，女性11.4%，平均年齡67.2±6.8歲。接受ACEI、ARB、ACEI/ARB、β受體阻滯劑、CCB和T-TLD治療的患者數分別為52887、7278、60165、24099、 98950和68639例。平均隨訪時間為42.9 15個月。至研究結束時，每種抗高血壓藥物與其他所有抗高血壓藥物的總體卒中發生風險比值和計算得到的血壓差異見下表。
原文
Long-Term Hypertensive Therapy and Stroke Prevention: A Meta-Analysis
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March 15, 2015, 9:45 - 10:30 AM
________________________________________
Disclosures
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Authors
Bertrand Njume Mukete, Mark Cassidy, Keith Ferdinand, Thierry LeJemtel, Tulane University School of Medicine, New Orleans, LA, USA
Abstract
Background:
Stroke yearly produces about 6.7 million worldwide deaths as the second leading cause. Pharmacotherapy for hypertension, an independent stroke risk factor, significantly reduces incidence. Although prior meta-analyses demonstrate various antihypertensive classes are superior to placebo in reducing stroke risk, which class is most effective is unclear.
Methods:
A systematic MEDLINE search included only randomized antihypertension controlled clinical trials (RCT) published between 1999-2014 in adults with stroke as a primary or secondary outcome. Five classes compared against all others were: angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers (B-blocker), calcium channel blockers (CCB), thiazide-thiazide like diuretics (T-TLD). Among 17 RTCs with 30 comparative arms, risk ratio assessed effect size and a fix and random model calculated summary effect size.
Result:
Among 251,853 total patients (46 11.4% female; mean age 67.2+- 6.8 years), there were 52,887; 7,278; 60,165; 24,099; 98,950; and 68,639 patients in the ACEI, ARB, ACEI/ARB, B-blocker, CCB and T-TLD groups respectively. The mean follow-up was 42.9 15 months. The study end calculated class Blood Pressure difference and summary stroke risk ratio for each class versus all others is depicted (figure 1).
Conclusion:
Among all classes, CCBs were most effective long-term in reducing stroke incidence, whereas B-blockers were associated with significantly increased risk.
參考文獻：Bertrand Njume Mukete,et al. Abstract Presented at: American College of Cardiology Scientific Session & Expo; March 15, 2015, 9:45 - 10:30 AM
