从LIFE和VALUE试验看ARB的降压地位

目的为了评价血管紧张素II受体拮抗剂(ARB)的抗高血压地位及是否存在降压以外的心血管保护作用。方法入选国际上符合大规模(>1万人/年)随机双盲对照,有关ARB的高血压临床试验,其中主要终点事件有脑卒中、急性心肌梗死、心力衰竭、致死性心血管病、总死亡率。对入选结果进行综合分析及统计学处理。结果符合入选的有LIFE和VALUE试验二项,LIFE试验ARB总体效果优于对照组(β-受体阻滞剂),认为ARB存在降压以外的心血管保护作用,但VALUE试验中ARB总体效果不如对照组氨氯地平。结论ARB与其它降压药效果无明显差别。     

依那普利与厄贝沙坦对系膜增生性肾炎的疗效观察

目的观察依那普利和厄贝沙坦对治疗系膜增生性肾炎患者蛋白尿、血尿的有效性和安全性。方法诊断系膜增生性肾炎共40例,其中,选自2001~2003年20例,男11例,女9例。年龄10~44岁。未使用ACEI(血管紧张素转换酶抑制剂)、ARB(血管紧张素转换酶受体拮抗剂)为对照组。选自2004-06~2005-01 20例,男12例,女8例。年龄13~48岁。使用依那普利2.5~10 mg,2次/d+厄贝沙坦150 mg/d。治疗过程中检测24 h尿蛋白定量、尿沉渣红细胞计数,血肌酐、血钾2、4 h尿量,并记录血压及不良反应。结果用依那普利+厄贝沙坦组24 h尿蛋白治疗0、4、6、8周分别为(2.14±0.78)g/d、(0.76±0.43)g/d,(0.49±0.30)g/d,(0.51±0.31)g/d;对照组分别为(2.01±0.67)g/d,(1.43±0.76)g/d,(0.78±0.58)g/d,(0.72±0.56)g/d,用依那普利+厄贝沙坦组尿沉渣红细胞计数0、4、6、8周分别为(454±189)万/mL,(85±57)万/mL,(26±14)万/mL,(23±11)万/mL,对照组分别为(370±175)万/mL,(136±53)万/mL,(49±22)万/mL,(35±23)万/mL。2例服用依那普利出现干咳,无低血压、高血钾、尿量减少、肾功能恶化发生。结论依那普利+厄贝沙坦减少尿蛋白、血尿快于对照组,疗效好,对血压影响不大,副作用轻,安全性好。     

沙库巴曲缬沙坦与ACEI/ARB类药物用于射血分数中间值心力衰竭的有效性与安全性比较:一项系统评价

目的：系统评价沙库巴曲缬沙坦与肾素-血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂（ACEI/ARB）类药物用于射血分数中间值心力衰竭患者的有效性和安全性。方法：系统检索各大中英文文献数据库中与沙库巴曲缬沙坦治疗射血分数中间值心力衰竭有关的随机对照试验RCT。2名研究者独立进行文献筛选,确定纳入的原始研究。进行文献质量评价和数据提取后,采用Review manager 5.3软件进行Meta分析。结果：共纳入12篇临床研究,涉及1 310例患者。Meta分析结果显示,主要结局指标方面,沙库巴曲缬沙坦组心力衰竭再住院率[RR＝0.50,95% CI （0.37,0.67）,P<0.000 01]低于ACEI/ARB组,纽约心脏病协会心功能分级改善显效率[RR＝1.67,95% CI （1.34,2.07）,P<0.01]和总有效率[RR＝1.16,95% CI （1.07,1.25）,P<0.000 01]高于ACEI/ARB组,有效率[RR＝0.79,95% CI （0.64,0.98）,P=0.04]低于对照组,组间差异均有统计学意义;2组心血管相关死亡率[OR＝0.51,95% CI （0.21,1.23）,P=0.13]相比,组间差异无统计学意义。安全性方面,症状性低血压、高血钾和肾功能恶化的发生率,2组间比较差异均无统计学意义。结论：沙库巴曲缬沙坦对射血分数中间值心力衰竭患者有效,与ACEI/ARB类药物相比,该药可进一步降低该类患者的心力衰竭再住院率、改善心功能且安全性相似。     

影响血管紧张素Ⅱ作用和合成的新途径及研究进展

肾素-血管紧张素系统(RAS)与多种疾病相关。作为RAS的最终效应途径,血管紧张素II起到了关键作用。本文综述了能够影响其合成及作用的主要途径:血管紧张素II受体拮抗剂(ARB)、糜酶(chymase)抑制剂和晚近发现的ACE2类物质及其相关研究。     

Relationships of plasma lipoprotein(a) levels with insulin resistance in hypertensive patients

Background

Lipoprotein(a) [Lp(a)] is an emergent cardiovascular risk factor that is related to the presence and severity of cardiovascular damage in hypertensive patients. In these patients, insulin resistance is frequently detected but its relationship with plasma Lp(a) is not clear. The aim of this study was to examine the relationships between Lp(a) and variables of glucose metabolism in hypertension.

Methods

In 527 consecutive, non-diabetic, middle-aged hypertensive patients we measured anthropometric indexes, 24-hour creatinine clearance, lipid profile including Lp(a) levels, fasting glucose, insulin and C-peptide, and calculated the Homeostatic Model Assessment (HOMA) index.

Results

Lp(a) levels were significantly and progressively lower with increasing HOMA-index values. Lp(a) was inversely related to fasting glucose, insulin, and C-peptide, HOMA-index, and creatinine clearance and directly related to LDL-cholesterol. Multiple regression analysis adjusted for age, sex, body mass index, blood pressure, smoking habit, alcohol intake, renal function, lipid profile, history of cardiovascular events, and drug use showed that HOMA-index and creatinine clearance were inversely and independently associated to Lp(a) levels.

Conclusions

Insulin resistance and higher fasting insulin levels are associated with lower plasma Lp(a) in hypertensive patients. This association might be relevant in the assessment of cardiovascular risk in these patients.