钙拮抗剂降压治疗对心脑血管事件影响:随机临床试验汇总评估

Major Outcomes of Calcium Channel Blockers Based Blood-Pressure-Lowering Treatments Trials

目的汇总分析抗高血压随机临床试验,评估钙拮抗剂(CCB)降压治疗对高血压或心血管病患者心脑血管事件及总死亡的影响。方法入选试验的标准:以CCB为基础的降压治疗并以安慰剂或利尿剂/β阻滞剂为对照的前瞻性随机临床试验,且样本数在400人以上,研究终点包括脑卒中,冠心病及总死亡。汇总分析16个试验(包括113035例患者),评估CCB长期治疗对高血压或心血管病患者心脑血管事件及总死亡的影响。结果汇总分析表明:CCB与安慰剂比较(8个试验,29545例多为老年高血压的患者),CCB明显减少了患者的脑卒中,冠心病,心力衰竭危险(31%,13%,34%)及总死亡(14%)。CCB与利尿剂/β阻滞剂比较(8个试验,83490例多为高血压伴高危因素的患者),CCB则轻度减少了脑卒中、冠心病危险(14%,9%)及总死亡(12%),但增加了心力衰竭危险(5%)。结论与安慰剂比较的试验汇总分析表明,CCB对心血管病或高血压患者长期降压治疗的有益证据是明确的;与利尿剂/β阻滞剂比较,轻度降低脑卒中、冠心病及总死亡危险。

Objective To assess the effects of calcium channel blocker （CCB） on cardiovascular events and mortalities in patients with hypertension or cardiovascular diseases by reviewing randomised clinical trials. Methods The inclusion criteria for selection of trials： prospective randomized trials of CCB-based blood-pressure-lowering treatment, compared with placebo or diuretics（DUT） or β-blockers （ BB） ; sample size≥400 patients ; study endpoint including stroke, coronary heart disease（CHD） , and total death. Fifteen trials with 113 035 individuals were reviewed. Results The findings showed in placebo-controlled trials {8 trials,29 545 patients mostly with old hypertensives） CCB reduced stroke risk （31%）, CHD （13%）, heart failure （34%） and total mortality （14% ）, however, as compared with DUT or BB-controlled （8 trials, 83 490 patients mostly with hypertension） CCB decrease stroke and CHD risk by 14% and 9%, respectively, and total mortality （12%） as well, but increased the risk of heart failure （ 5% ）. Conclusion Reviews of placebo-controlled trials showed that CCB blood-pressure-lowering treatment have significant effect on patients with hypertension or cardiovascular diseases. As compared with DUT or BB, the reduction of stroke, CHD and death risk were slightly in favor of CCB.