患有高血压的成年人中的雷宁 - ангиотензин - 阿尔多素系统调节剂:随机对照试验的网络元分析
Xiaoyan Yi1,2, Shumin Yang1, Jun Yang3,4
1Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing, 400016, China.
Drugs
|September 23, 2024
概括
矿物质皮质类受体对抗剂 (MRA) 是唯一的氨酸-血管酶-氨系统 (RAAS) 调节剂,在高血压中提供生存益处. 尽管高血压的风险较高,但应该考虑在高血压患者中更早和更广泛地使用MRA.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 对于高血压管理的氨酸- ангиотензин- алдостерон系统 (RAAS) 调节剂的最佳选择仍然不清楚.
- 现有的RAAS调节器在降低血压的有效性和安全性方面各不相同.
- 这项研究解决了对RAAS调节器在成人高血压群体中的比较数据的需求.
研究的目的:
- 在成人高血压患者中比较不同RAAS调节剂的疗效和安全性.
- 确定哪些RAAS调节器提供生存益处 (减少全因和心血管死亡率).
- 评估安全性概况,包括咳,头,,高血和低血压等不良事件.
主要方法:
- 在PubMed,CENTRAL和Embase数据库中进行系统的文献搜索.
- 在频率主义框架内使用随机效应模型进行的网络元分析.
- 主要疗效结局:全因死亡率;次要疗效结局:心血管死亡率;耐受性:由于不良事件而中止;安全性:特定不良事件.
主要成果:
- 与安慰剂相比,MRAs显著降低了全因和心血管死亡率.
- 其他RAAS调节剂没有显示出与安慰剂相比,所有原因或心血管死亡率的显著降低.
- 与ACEI,ARB和DRI相比,MRA显示出更高的生存益处;ACEI增加了咳风险,ARB增加了头,低血压和高血症风险,MRA增加了高血症风险.
结论:
- 尽管高血压的风险增加,但MRA是唯一的RAAS调节剂,在高血压的成年人中显示出生存益处.
- 这些发现挑战了目前推MRA作为第四线治疗的指导方针.
- 数据表明,MRAs在高血压管理中需要更早,更广泛的处方.
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