Cardiovascular and cerebrovascular outcomes in elderly hypertensive patients treated with either ARB or ACEI

变换酶禁止者(ACEI ) 和血管收缩素受体 blockers (ARB ) 的 BackgroundAlthough 血管收缩素在高血压的治疗是同等地重要的，有更少的证据他们是否有相等的心血管、脑血管的保护的效果，特别在年长的高血压的病人。这研究试图澄清代表性的学习包括了的这未解决的 issue.MethodsThis 收到了 ARB 或 ACEI 在 2007 年 1 月和 2011 年 5 月之间的超过二个月的有高血压的 933 个年老的男病人上的临床的数据。主要结果是心血管的死亡，非致命的心肌的梗塞，和非致命的击合成。第二等的端点是不稳定的咽峡炎，新 atrial 纤维性颤动，和中部的后续时间是的短暂 ischemic attack.ResultsThe 24 个月。年龄，药类型，服的梗塞历史，肾的机能障碍历史是主要端点的独立预言者。一个主要端点事件的出现的风险比 ACEI 组在 ARB 组是更高的[P = 0.037，危险比率(HR ) ：2.124， 95% 信心间隔(95% CI ) ：1.048-4.306 ] 。Kaplan-Meier 方法也建议主要端点出现的率比 ACEI 组在 ARB 组是更高的(P = 0.04 ) 。关于第二等的端点，二只治疗手臂之间没有重要差别(P = 0.137， HR：1.454， 95% CI：0.888-2.380 ) 。耐心的年龄和冠的心疾病历史是第二等的 endpoint.ConclusionACEI 的独立预言者是比在与高血压在年老的病人减少心血管、脑血管的病态和死亡的 ARB 更有效的。

Background Although angiotensin converting enzyme inhibitors （ACEI） and angiotensin receptor blockers （ARB） are equally important in the treatment of hypertension, there is less evidence whether they have equal cardiovascular and cerebrovascular protective effects, especially in elder hypertensive patients. This study aims to clarify this unresolved issue. Methods This cross-sectional study included clinical data on 933 aged male patients with hypertension who received either an ARB or ACEI for more than two months between January 2007 and May 2011. The primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary endpoints were unstable angina, new atrial fibrillation, and transient ischemic attack. Results The median follow-up time was 24 months. Age, drug types, cerebral infarction history, renal dysfunction history were the independent predictors of the primary endpoint. The risk of an occurrence of a primary endpoint event was higher in the ARB group than the ACEI group [P = 0.037, hazard ratios （HR）： 2.124, 95% confidence interval （95% CI）： 1.048-4.306]. The Kaplan-Meier method also suggests that the rate of primary endpoint occurrence was higher in the ARB group than the ACEI group （P = 0.04）. In regard to the secondary endpoints, there were no significant differences between the two treatment arms （P = 0.137, HR： 1.454, 95% CI： 0.888-2.380）. Patient age and coronary heart disease history were independent predictors of the secondary endpoint. Conclusion ACEI were more effective than ARB in reducing cardiovascular and cerebrovascular morbidity and mortality in aged patients with hypertension.