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血管紧张素转换酶抑制剂与主动脉破裂:一项基于人群的病例对照研究

Angiotensin-converting enzyme inhibitors and aortic rupture:a population-based case-control study
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摘要 背景:血管紧张素转换酶(ACE)抑制剂可预防动物主动脉瘤的扩张和破裂。本研究旨在探讨ACE抑制剂与腹主动脉瘤患者瘤体破裂的相关性。方法:在加拿大安大略省利用连锁管理数据库进行一项基于人群的病例对照研究。样本包括在1992年4月1日至2002年4月1日间初步诊断为破裂或完好腹主动脉瘤而住院、年龄】65岁的连续患者(n=15326)。 Background: Angiotensin-converting enzyme(ACE) inhibitors prevent the expansion and rupture of aortic aneurysms in animals. We investigated the association between ACE inhibitors and rupture in patients with abdominal aortic aneurysms. Methods: We did a population-based case-control study of linked administrative databases in Ontario, Canada. The sample included consecutive patients older than 65(n=15 326) admitted to hospital with a primary diagnosis of ruptured or intact abdominal aortic aneurysm between April 1, 1992, and April 1, 2002. Findings: Patients who received ACE inhibitors before admission were significantly less likely to present with ruptured aneurysm(odds ratio[OR] 0.82, 95%CI 0.74-0.90) than those who did not receive ACE inhibitors. Adjustment for demographic characteristics, risk factors for rupture, comorbidities, contraindications to ACE inhibitors, measures of health-care use, and aneurysm screening yielded similar results(0.83, 0.73-0.95). Consistent findings were noted in subgroups at high risk of rupture, including patients older than 75 years and those with a history of hypertension. Conversely, such protective associations were not observed for βblockers(1.02, 0.89-1.17), calcium channel blockers(1.01, 0.89-1.14), αblockers(1.15, 0.86-1.54), angiotensin receptor blockers(1.24, 0.71-2.18), or thiazide diuretics(0.91, 0.78-1.07). Interpretation: ACE inhibitors are associated with a reduced risk of ruptured abdominal aortic aneurysm, unlike other antihypertensive agents. Randomised trials of ACE inhibitors for prevention of aortic rupture might be warranted.
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