肾素-血管紧张素阻滞剂与钙通道阻滞剂长期治疗高血压合并糖尿病患者的疗效和安全性的比较

目的：比较使用肾素-血管紧张素（renin-angiotensin,RAS）阻滞剂与钙通道阻滞剂（calcium channel blockers,CCBs）长期治疗高血压合并糖尿病患者的疗效和安全性。方法：通过检索PubMed、Cochrane Central Register of Controlled Trials、万方数据库,收集公开发表的关于RAS阻滞剂与CCBs长期治疗高血压合并糖尿病的疗效和安全性的随机对照试验（randomized controlled trial,RCT）。根据改良版的Jadad量表对符合纳入标准的研究进行质量评价,采用Stata 12.0软件进行Meta分析。结果：共纳入12 RCTs,包括14 564人。Meta分析显示：在长期治疗过程中,RAS阻滞剂治疗组和CCBs治疗组的全因死亡率、心血管事件死亡率以及心血管事件、心肌梗死、心绞痛的发生率均没有明显差异。与CCBs相比,RAS阻滞剂可显著降低终末期肾病[RR=0.82,95% CI（0.68,0.92）,P=0.031]和心衰[RR=0.77,95% CI（0.68,0.86）,P<0.001]的发生率,但会增加卒中的发生风险[RR=1.15,95% CI（1.00,1.33）,P=0.046]。RAS阻滞剂治疗后更易发生干咳[RR=2.1,95% CI（1.00,4.41）,P=0.046],CCBs治疗过程中更易出现水肿[RR=0.48,95% CI（0.25,0.94）,P=0.032]。结论：在高血压合并糖尿病患者的长期治疗中,RAS阻滞剂治疗发生卒中的风险大于CCBs,CCBs长期治疗发生心衰的风险明显大于RAS阻滞剂。RAS阻滞剂能延缓肾脏疾病的进展。

Comparison of efficacy and safety ofrenin-angiotensin blockers and calcium channel blockers for long-term treatment of hypertensive patients with diabetes:A meta analysis of randomized controlled trials

OBJECTIVE To evaluate the efficacy and safety of renin-angiotensin (RAS) blockers and calcium channel blockers (CCBs) for long-term treatment of hypertensive patients with diabetes. METHODS Published randomized controlled trials (RCTs) on the efficacy and safety of RAS blockers and CCBs in the long-term treatment of hypertension with diabetes were collected by searching PubMed, Cochrane Central Register of Controlled Trials, and Wanfang Database. The quality of studies were evaluated according to modified Jadad scale. Meta analysis was performed by Stata 12.0 software. RESULTS A total of 12 RCTs including 14 564 patients were included. Meta-analysis showed that there was no significant difference in all-cause mortality, cardiovascular event mortality, and the incidence of cardiovascular events, myocardial infarction, and angina pectoris between the RAS blocker and CCBs treatment groups during long-term treatment. Compared with CCBs, RAS blockers can significantly decrease the incidence of end-stage renal disease[RR=0.82, 95% CI (0.68,0.92), P=0.031] and heart failure[RR=0.77, 95% CI (0.68, 0.86), P<0.001], but increased the incidence of stroke[RR=1.15, 95% CI (1.00, 1.33), P=0.046]. With regarding to the adverse reaction, patients with RAS blockers were more likely to experience dry cough[RR=2.1, 95% CI (1.00, 4.41), P=0.046], while patients who received CCBs were more prone to edema[RR=0.48, 95% CI (0.25, 0.94), P=0.032]. CONCLUSION In the long-term treatment of hypertensive patients with diabetes, the risk of stroke is greater with RAS blockers than with CCBs, and the risk of heart failure is significantly greater with long-term treatment with CCBs than with RAS blockers. RAS blockade can delay the progression of renal disease.