对接受脏移植的人进行抗高血压治疗
Patrizia Natale1,2,3, Pamela Kl Mooi4, Suetonia C Palmer5
1Sydney School of Public Health, The University of Sydney, Sydney, Australia.
The Cochrane database of systematic reviews
|July 31, 2024
概括
通道阻断剂 (CCB) 可能会减少移植患者的死亡和移植损失. 血管激素受体抑制剂 (ARB) 也可能减少移植损失,但其他治疗方法和结果的证据仍然不确定.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植免疫学 移植免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 降血压 (BP) 治疗对移植后的结果的比较疗效尚未得到充分证实.
- 之前的审查表明通道阻断剂 (CCB) 改善了移植功能并防止了移植损失,对其他药物的证据有限.
- 这一综述更新了2009年关于移植患者抗高血压药物的科克莱恩综述.
研究的目的:
- 在移植患者中比较各种抗高血压药物类别和组合的益处和危害.
- 评估不同降血压策略对患者重要结果的影响.
主要方法:
- 搜索了科克伦脏和移植研究登记册,截至2024年7月.
- 包括移植接受者 (移植后≥2周) 中血压降低剂的随机对照试验 (RCT) 和准RCT.
- 独立评估偏差风险和提取数据;使用随机效应模型总结估计;用GRADE评估证据确定性.
主要成果:
- 包括97项研究 (8706名参与者). 与安慰剂/标准护理相比,CCB可能会减少全因死亡 (中等确定性) 和移植损失 (中等确定性).
- CCBs可能对估计的淋巴细胞过率 (eGFR) 和急性排斥几乎没有影响,但可能会降低心和腹血压 (确定性低).
- 血管激素受体抑制剂 (ARB) 可能会减少移植损失 (确定性低) 和血压,但对死亡和eGFR等其他结果的影响是不确定的 (确定性低).
结论:
- 通道阻断剂 (CCB) 可能会降低移植受体的死亡率和移植损失.
- 血管激素受体抑制剂 (ARBs) 可能会减少移植损失,但血管激素转化酶抑制剂 (ACEi) 和其他结局的ARBs的证据尚不确定.
- 双重疗法,α抑制剂,矿物质皮质类受体对抗剂和对对照治疗的比较效应需要进一步研究.
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