CCB及RAAS抑制剂降压治疗预防脑血管事件差异的真实世界研究  

Real world study of differences between CCB and RAAS inhibitors in antihypertensive therapy to prevent cerebrovascular events

作　　者：宁丽晔 曾六仔 陈春晖 刘香 傅宴 郑国燕 黎智森 贾国良 曾广民 NING Li-ye;ZENG Liu-zai;CHEN Chun-hui(Cardiovascular Center,Dongguan Kanghua Hospital,Dongguan 523000,China)

机构地区：[1]东莞康华医院心血管病中心,523000 [2]东莞市大朗社区卫生服务中心,523770

出　　处：《中国实用医药》2023年第8期101-104,共4页China Practical Medicine

摘　　要：目的研究钙通道阻滞剂(CCB)及肾素-血管紧张素-醛固酮系统(RAAS)抑制剂降压治疗预防脑血管事件差异的真实世界。方法对915例高血压患者进行资料查看、筛选、分析,观察患者血压控制及终点事件发生情况,比较用药CCB、RAAS抑制剂对减少心脑血管事件效果的真实世界情况。结果随访时间2.0~6.5年,平均随访时间4.5年。915例高血压患者中,482例患者采用单一CCB治疗,433例患者采用单一RAAS抑制剂治疗。用药CCB患者收缩压降低幅度略大于用药RAAS抑制剂患者,舒张压降低幅度略小于用药RAAS抑制剂患者,但差异无统计学意义(P>0.05);随访至终点时,用药CCB患者脑卒中发生率为5.60%(27/482),低于用药RAAS抑制剂患者的6.47%(28/433),经R语言生存分析差异具有统计学意义(P=0.016<0.05)。用药CCB患者心肌梗死发生率为2.90%(14/482),高于用药RAAS抑制剂患者的2.31%(10/433),经R语言生存分析差异无统计学意义(P=0.920>0.05)。用药CCB患者总死亡率为4.56%(22/482),用药RAAS抑制剂患者总死亡率为4.62%(20/433),经R语言生存分析差异无统计学意义(P=0.872>0.05)。结论CCB降压治疗预防脑卒中的效果优于RAAS抑制剂,显示CCB对脑卒中的一级预防具有更多的优势。Objective To study the real world of differences between calcium channel blocker(CCB)and renin-angiotensin-aldosterone system(RAAS)inhibitors in antihypertensive therapy to prevent cerebrovascular events.Methods Data of 915 hypertensive patients were reviewed,screened and analyzed to observe the control of blood pressure and the occurrence of endpoint events,and to compare the real world situation of the effect of CCB and RAAS inhibitors on reducing cerebrovascular events.Results The follow-up time ranged from 2.0 to 6.5 years,with a mean follow-up time of 4.5 years.Of the 915 hypertensive patients,482 patients were treated with a single CCB and 433 patients were treated with a single RAAS inhibitor.The reduction in systolic blood pressure in patients on CCB was slightly greater than that in patients on RAAS inhibitors,and the reduction in diastolic blood pressure was slightly less than that in patients on RAAS inhibitors,but the difference was not statistically significant(P>0.05).At the end of follow-up,the incidence of stroke was 5.60%(27/482)in patients on CCB,which was lower than that of 6.47%(28/433)in patients on RAAS inhibitors,and the difference was statistically significant by R-language survival analysis(P=0.016<0.05).The incidence of myocardial infarction was 2.90%(14/482)in patients on CCB,which was higher than that of 2.31%(10/433)in patients on RAAS inhibitors,and the difference was not statistically significant by R-language survival analysis(P=0.920>0.05).The overall mortality rate was 4.56%(22/482)in patients on CCB,and 4.62%(20/433)in patients on RAAS inhibitors,and the difference was not statistically significant by R-language survival analysis(P=0.872>0.05).Conclusion The effect of CCB in antihypertensive treatment for stroke prevention is better than that of RAAS inhibitors,indicating that CCB has more advantages in the primary prevention of stroke.

关 键 词：高血压 钙通道阻滞剂 肾素-血管紧张素-醛固酮系统抑制剂 脑卒中 心肌梗死 

分 类 号：R544.1[医药卫生—心血管疾病]