目的 综合评价利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体阻滞剂(ARB)和钙通道阻滞剂(CCB)5类降压药物对新发糖尿病(NOD)的影响。方法 检索有关降压药物和NOD的临床试验,在WinBUGS 1.4.3软件中构建随机效应贝叶斯模型,估计这5类药物以及安慰剂之间的OR值及其优劣顺序。结果 共纳入28项临床试验,将安慰剂作为被比较者,OR值分别为:ARB 1.23(95%CI:1.087~1.399),ACEI 1.204(95%CI:1.033~1.424),CCB 0.928 9(95%CI:0.779 3~1.095),β受体阻滞剂 0.738 4(95%CI:0.604 7~0.890 6),利尿剂 0.789 4(95%CI:0.654~0.928 3)。其中,ARB引发NOD的概率最低,其后依次为ACEI、安慰剂、CCB、利尿剂和β受体阻滞剂。结论 ARB、ACEI会减少NOD发生的风险,而CCB、利尿剂和β受体阻滞剂会增加NOD发生的风险。
Abstract
OBJECTIVE To comprehensively evaluate the influence of antihypertensive agents on new-onset diabetes, including diuretics, beta-antagonists, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) and calcium channel blockers (CCB). METHODS Clinical trials were searched about antihypertensive agents and NOD. The ORs and rankings of the five classes of drugs and placebo were estimated, using random effects Bayesian models in WinBUGS version 1.4.3. RESULTSTwenty-eight clinical trials were included in this study. Compared to placebo, the ORs of the five classes of drugs for causing NOD were as follows:ARB 1.23(95%CI:1.087-1.399), ACEI 1.204(95%CI:1.033-1.424), CCB 0.928 9(95%CI:0.779 3-1.095), beta-antagonists 0.738 4 (95%CI:0.604 7-0.890 6), diuretics 0.789 4(95%CI:0.654~0.928 3). CONCLUSION The probability of causing NOD is lowest for ARB followed by ACEI, placebo, CCB, diuretics and beta-antagonists. ARB and ACEI can reduce the risk of NOD. CCB, diuretics and beta-antagonists can increase the risk of NOD.
关键词
降压药物 /
新发糖尿病 /
网络Meta分析
{{custom_keyword}} /
Key words
antihypertensive agent /
new-onset diabetes /
network meta-analysis
{{custom_keyword}} /
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] SU H. Antihypertensive agents may increase new-onset diabetes. China Pharm News(中国医药报). 2009-7-14(B02). [2] LIU W, JIA A Q. The application trend and economic analysis of antihypertensive drugs. Chin Pharm J(中国药学杂志),2003,38(3):225-226. [3] WILKINS R. New drugs for the treatment of hypertension. Ann Intern Med, 1959,50(1): 1-12. [4] WANG R Q, LI Y N, QIN X J. The effect of antihypertensive drugs on glucose metabolism and its enlightenment to clinical rational use of drug. Chin J Pharm acovigilance(中国药物警戒),2009,6(5):298-301. [5] LIAO W Q, CHEN P Y. Bayesian mixed treatment comparisons and implementation using WinBUGS. Chin J New Drugs(中国新药杂志),2010,19 (24) :2244-2248. [6] SCHULZ K F, ALTMAN D G, MOHER D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Ann Intern Med, 2010, 152(11): 726-732. [7] LIAO W Q. Simulation studies on multiple treatments meta-analysis and indirect comparisons. Guangzhou: Southern Medical University, 2011. [8] YUSUF S, DIENER H C, SACCO R L, et al. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med,2008, 359(12):1225-1237. [9] MCMURRAY J J, HOLMAN R R. Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med, 2010, 362(16):1477-1490. LITHELL H, HANSSON L, SKOOG I, et al. The study on cognition and prognosis in the Elderly (SCOPE): Principal results of a randomized double-blind intervention trial. J Hyperten,2003, 21(5):875-886. GRANGER C B, MCMURRAY J J, YUSUF S, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensinconverting-enzyme inhibitors:The CHARM-Alternative trial. Lancet, 2003, 362(9386):772-776. YUSUF S, PFEFFER M A, SWEDBERG K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARMPreserved Trial. Lancet,2003, 362(9386):777-781. YUSUF S, TEO K. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in highrisk patients intolerant to angiotensin-converting enzyme inhibitors: A randomized controlled trial. Lancet, 2008,372(9644):1174-1183. SAWADA T, YAMADA H, DAHLOF B, et al. Effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high cardiovascular risks: KYOTO HEART Study. Eur Heart J, 2009,30(20):2461-2469. OGIHARA T, NAKAO K, FUKUI T, et al. Effects of candesartan compared with amlodipine in hypertensive patients with high cardiovascular risks: Candesartan antihypertensive survival evaluation in Japan trial. Hypertension, 2008,51(2):393-398. JULIUS S, KJELDSEN S E, WEBER M, et al. Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: The VALUE randomised trial. Lancet, 2004,363(9426):2022-2031. LINDHOLM L H, IBSEN H, DAHL F B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol. Lancet, 2002,359(9311):1004-1010. LINDHOLM L H, PERSSON M, ALAUPOVIC P, et al. Metabolic outcome during 1 year in a newly-detected hypertensives: Results of the Antihypertensive Treatment and Lipid Profi le in a North of Sweden Efficacy Evaluation (ALPINE Study). J Hypertens, 2003, 21: 1563-1574. DREAM TRIAL INVESTIGATORS, BOSCH J, YUSUF S, et al. Effect of ramipril on the incidence of diabetes. N Engl J Med, 2006,355(15):1551-1562. FOX K M. European trial on reduction of cardiac events with perindopril in stable coronary artery disease investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: Randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet, 2003,362(9386):782-788. VERMES E, DUCHARME A, BOURASSA M G, et al. Studies of left ventricular dysfunction. Enalapril reduces the incidence of diabetes in patients with chronic heart failure: Insight from the studies of left ventricular dysfunction (SOLVD). Circulation,2003,107(9):1291-1296. YUSUF S, GERSTEIN H, HOOGWERF B, et al. Ramipril and the development of diabetes. JAMA, 2001,286: 1882-1885. The PEACE Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med, 2004,351(20):2058-2068. HANSSON L, LINDHOLM L H, NISKANEN L, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: The captopril prevention project (CAPPP) randomized trial. Lancet, 1999,353 (9153):611-616. JANDELEIT-DAHM K A, TIKELLIS C, REID C M, et al. Why blockade of the renin-angiotensin system reduces the incidence of new-onset diabetes. J Hypertens, 2005,23: 463-473. THORNLEY-BROWN D, WANG X, WRIGHT J T J R, et al. Diff ering eff ects of antihypertensive drugs on the incidence of diabetes mellitus among patients with hypertensive kidney disease. Arch Intern Med,2006, 166(7):797-805. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA, 2002,288(23):2981-2997. LIU L, ZHANG Y, LIU G, et al. The Felodipine Event Reduction (FEVER) study: A randomized long-term placebo-controlled trial in Chinese hypertensive patients. J Hypertens, 2005, 23(12): 2157-2172. BROWN M J, PALMER C R, CASTAIGNE A, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet, 2000,356(9227): 366-372. DAHL F B, SEVER P S, POULTER N R, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendrofl umethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): A multicentre randomized controlled trial. Lancet,2005, 366(9489): 895-906. PEPINE C J, HANDBERG E M, COOPER-DEHOFF R M, et al. A calcium antagonist vs. a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease: The International Verapamil-Trandolapril Study (INVEST): A randomized controlled trial. JAMA,2003,290(21): 2805-2816. WILHELMSEN L, BERGLUND G, ELMFELDT D, et al. Beta-blockers versus diuretics in hypertensive men: Main result from the HAPPHY trial. J Hypertens, 1987, 5(5): 560-572. MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: Principal results. BMJ, 1992, 304(6824): 405-412. FLETCHER A, AMERY A, BIRKENHAGER W, et al. Risks and benefi ts in the trial of the European Working Party on High Blood Pressure in the Elderly. J Hypertens, 1991, 9(3): 225-230. SAVAGE P H, PRESSEL S L, CURB D, et al. Infl uence of long-term, lowdose, diuretic-based antihypertensive therapy on glucose, lipid, uric acid, and potassium levels in older men and women with isolated systolic hypertension. Arch Intern Med,1998,158(7): 741-751. GENG D F, JIN D M, WU W, et al. Angiotensin receptor blockers for prevention of new-onset type 2 diabetes: A meta-analysis of 59,862 patients. Int J Cardiol(国际心脏病学杂志),2012,155(2):236-242. GENG D F, JIN D M, WU W, et al. Angiotensin converting enzyme inhibitors for prevention of new-onset type 2 diabetes mellitus: A meta-analysis of 72,128 patients. Int J Cardiol (2012), doi:10. 1016/j. ijcard. 2012. 06. 125. TOCCI G,PANENI F, PALANO F, et al. Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diabetes: A meta-analysis of placebo-controlled clinical trials. Am J Hyperten Sion,2011,24(5):582-590. American Diabetes Association. Position statement: Diagnosis and classification of diabetes mellitus. Diabetes Care, 2004,27 (suppl 1):5-10.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
基金
国家社会科学基金(11BFX098)
{{custom_fund}}
PDF(658 KB)
