第一线抗高血压治疗类别的比较分析
Ran Abuhasira1, Nitzan Burrack2, Adi Turjeman3
1Department of Internal Medicine B, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
The American journal of medicine
|October 18, 2024
概括
对于高血压,血管激素转化酶抑制剂 (ACEis),血管激素受体阻断剂 (ARB) 和通道阻断剂 (CCB) 与 thiazides 相比,对主要不良心血管事件具有类似的风险. β-阻断剂 (BBs) 与风险增加有关.
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.
- 公共卫生 公共卫生
背景情况:
- 对高血压的第一线单一治疗缺乏明确的指导,在没有特定的并发症的情况下,建议使用 thiazides, ACEis, ARBs 和 CCBs.
- 这些抗高血压类药物的现实世界比较有效性需要进一步调查.
研究的目的:
- 为了比较不同一线抗高血压单一治疗类的现实世界结果.
- 评估与初始高血压治疗选择相关的主要心血管不良事件的长期风险.
主要方法:
- 在以色列进行全国性回顾性新用户队列研究 (2008-2021年).
- 包括新诊断高血压患者开始单药治疗的患者.
- 倾向性得分匹配用于控制混因素.
- 主要综合结局:心肌梗塞,急性冠状动脉综合征,中风或心力衰竭.
主要成果:
- 研究包括97,639名患者;ACEis/ARBs是最常见的 (68.3%),其次是CCBs (16.3%),BBs (13.2%) 和 thiazides (2.2%).
- 与 thiazides 相比,主要结局的危险比为:BBs 1.44 (95% CI 1.25-1.66),CCBs 1.10 (95% CI 0.96-1.27) 和ACEis/ARBs 1.13 (95% CI 0.99-1.29).与 thiazides 相比,主要结局的危险比为:BBs 1.44 (95% CI 1.25-1.66),CCBs 1.10 (95% CI 0.96-1.27) 和ACEis/ARBs 1.13 (95% CI 0.99-1.29).
结论:
- 与用于第一线单一治疗时的 thiazides 相比,ACEis,ARBs 和 CCBs 显示了与主要心血管不良事件的风险相似.
- 与 thiazides 相比,β-阻断剂与重大心血管不良事件的风险显著增加有关.
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