Int J Cardiol:ARB类药物可作为高血压糖尿病患者预防卒中的一线用药

2016-07-24 phylis 译 MedSci原创

背景:血管紧张素转换酶抑制剂(ACEI)和血管紧张素II受体阻滞剂(ARB)联合治疗已全面阻断的肾素-血管紧张素-醛固酮系统,但各自的安全性和有效性的证据,特别是在预防卒中方面,仍是不足的。方法:使用台湾全民健康保险索赔数据,研究者确定了5445名18岁以上在1997-2010年新诊断高血压,从中筛选出2型糖尿病的患者。其中,2161例患者服用ACEI,1703例服用ARB类药物,165例服用AC

背景:血管紧张素转换酶抑制剂(ACEI)和血管紧张素II受体阻滞剂(ARB)联合治疗已全面阻断的肾素-血管紧张素-醛固酮系统,但各自的安全性和有效性的证据,特别是在预防卒中方面,仍是不足的。

方法:使用台湾全民健康保险索赔数据,研究者确定了5445名18岁以上在1997-2010年新诊断高血压,从中筛选出2型糖尿病的患者。其中,2161例患者服用ACEI,1703例服用ARB类药物,165例服用ACEI和ARB类药物,1416例患者没有服用ACEI和ARB。

结果:在随访期间,ARB组脑卒中发病密度是最低的(23.02/1000人年),其次是没有用ACEI和ARB药组,ACEI组和ARB联合ACEI组(分别为24.06,30.23,和37.86/1000人年,)。与不服药的患者相比,ACEI组校正风险比(HR)为1.27(95% CI 1.02-1.58),ARB组校正HR为0.95(95% CI 0.74-1.22)和ARB /联合ACEI组校正HR为1.56(95% CI 0.99-2.47)。大剂量ARB组卒中风险明显降低(校正HR为0.42,95% CI 0.24-0.75)。

结论:研究结果支持从卒中预防的角度来看,ARB作为高血压和糖尿病患者的一线降压药物。与ACEI治疗组相比,ARB的治疗组卒中的发生率减少了26%。

原始出处:

Pai PY, Muo CH, et al. Angiotensin receptor blockers (ARB) outperform angiotensin-converting enzyme (ACE) inhibitors on ischemic stroke prevention in patients with hypertension and diabetes - A real-world population study in Taiwan. Int J Cardiol. 2016 Jul 15


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  1. [GetPortalCommentsPageByObjectIdResponse(id=1781720, encodeId=0ab81e81720f9, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Sat Mar 25 06:55:00 CST 2017, time=2017-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135104, encodeId=ead2135104fe, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:19:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131785, encodeId=5ddc131e852b, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:35:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125605, encodeId=fea3125605f5, content=学习新知识了,不过ACEI类药物还有更多的作用靶点及机制,应该不逊色于ARB, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:26:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474025, encodeId=78aa14e402527, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Mon Jul 25 23:55:00 CST 2016, time=2016-07-25, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1781720, encodeId=0ab81e81720f9, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Sat Mar 25 06:55:00 CST 2017, time=2017-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135104, encodeId=ead2135104fe, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:19:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131785, encodeId=5ddc131e852b, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:35:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125605, encodeId=fea3125605f5, content=学习新知识了,不过ACEI类药物还有更多的作用靶点及机制,应该不逊色于ARB, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:26:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474025, encodeId=78aa14e402527, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Mon Jul 25 23:55:00 CST 2016, time=2016-07-25, status=1, ipAttribution=)]
    2016-09-25 1e10c84am36(暂无匿称)

    文章很好值得关注

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1781720, encodeId=0ab81e81720f9, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Sat Mar 25 06:55:00 CST 2017, time=2017-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135104, encodeId=ead2135104fe, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:19:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131785, encodeId=5ddc131e852b, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:35:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125605, encodeId=fea3125605f5, content=学习新知识了,不过ACEI类药物还有更多的作用靶点及机制,应该不逊色于ARB, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:26:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474025, encodeId=78aa14e402527, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Mon Jul 25 23:55:00 CST 2016, time=2016-07-25, status=1, ipAttribution=)]
    2016-09-20 1e10c84am36(暂无匿称)

    文章很好,非常有益

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1781720, encodeId=0ab81e81720f9, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Sat Mar 25 06:55:00 CST 2017, time=2017-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135104, encodeId=ead2135104fe, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:19:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131785, encodeId=5ddc131e852b, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:35:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125605, encodeId=fea3125605f5, content=学习新知识了,不过ACEI类药物还有更多的作用靶点及机制,应该不逊色于ARB, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:26:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474025, encodeId=78aa14e402527, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Mon Jul 25 23:55:00 CST 2016, time=2016-07-25, status=1, ipAttribution=)]
    2016-09-13 舒心和人

    学习新知识了,不过ACEI类药物还有更多的作用靶点及机制,应该不逊色于ARB

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1781720, encodeId=0ab81e81720f9, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Sat Mar 25 06:55:00 CST 2017, time=2017-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135104, encodeId=ead2135104fe, content=文章很好值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 25 17:19:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131785, encodeId=5ddc131e852b, content=文章很好,非常有益, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Tue Sep 20 22:35:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=125605, encodeId=fea3125605f5, content=学习新知识了,不过ACEI类药物还有更多的作用靶点及机制,应该不逊色于ARB, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160907/IMG57D00CF1965701770.jpg, createdBy=565c1948251, createdName=舒心和人, createdTime=Tue Sep 13 18:26:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474025, encodeId=78aa14e402527, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Mon Jul 25 23:55:00 CST 2016, time=2016-07-25, status=1, ipAttribution=)]

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镁的摄入可调节血压?

美国约有7000万人患有高血压,这是导致民众出现卒中和心脏病的主要风险之一,若控制卒中和心脏病发作的发生率,则控制民众血压为首要问题。专家们认为高血压是“沉默的杀手”,因为它的出现往往没有临床表现或先兆。印第安纳大学医学院的研究人员试图探究日镁摄入量与控制血压之间的关系。人们认为,镁与机体内300多种生化反应有关。虽然关于镁的摄入与血压调节之间关系的研究持续进行,但是人们普遍认为镁可维持机体神经和

AGS 2016:一线降压药不会增加老年人跌倒损伤风险,但是二线降压药会

根据美国老年学会会议上提出的研究,对于老年人跌倒受伤,一线抗高血压药物可能是安全的。俄勒冈州立大学的David S. Lee博士和他的同事们发现,二线高血压会增加各年龄组严重跌倒损伤的风险。他们对26408名年龄在50至85岁的参与者进行了研究,评估一线和二线降压药、他汀类药物和镇静剂对人群跌倒损伤风险的影响。结果表明,他汀类药物与一线抗高血压药不会增加所有参与者的严重跌倒受伤风险。数据显示,50