查詢結果分析
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頁籤選單縮合
題名 | 從ABCD及FACET臨床試驗談鈣離子阻斷劑在糖尿病病人的使用=Calcium Antagonists in Treating Diabetic Patients with Hypertension: Implications from ABCD and FACET |
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作者 | 曾慶孝; Tseng, Chin-hsiao; |
期刊 | 內科學誌 |
出版日期 | 19990800 |
卷期 | 10:4 1999.08[民88.08] |
頁次 | 頁139-143 |
分類號 | 418.22 |
語文 | chi |
關鍵詞 | 血管收縮素轉化酶抑制劑; 鈣離子阻斷劑; 第二型糖尿病; 高血壓; 臨床試驗; Angiotensin converting enzyme inhibitor; Calcium antagonist; Type 2 diabetes mellitus; Hypertension; Clinical trial; |
中文摘要 | 糖尿病病人發生高血壓時使用鈣離子阻隔劑的安全性在近年遭受到一些質疑。 有兩個臨床試驗針對第二型糖尿病併發高血壓時比較給予鈣離子阻斷劑及血管收縮素轉化 為抑制劑(angiotensin converting enzyme inhibitor, ACEI)的效用和安全性。在the Appropriate Blood Pressure Control in Diabetes (ABCD)試驗中比較enalapril 和 nisoldipine;而在the Fosinopril versus Amlodipine Cardiovascular Events Trial (FACET)試驗中是比較fosinopril 及amlodipine。此二試驗均以監測心臟血管疾病 的發生為次要目標(secondary endpoint)。ABCD試驗在平均追蹤五年後因為發現 nisoldipine的使用者在致死性與非致死性心肌梗塞的發生危險性高於enalapril組(調整 後相對危險為7.0,95%信賴區間為2.3~21.4),因此提前終止了高血壓組的試驗。在 FACET試驗中亦發現amlodipine組發生心臟血管疾病的危險性較fosinopril組高2.04倍( 95%信賴區間1.05~3.84)。此二臨床試驗均顯示糖尿病病人使用鈣離子阻斷劑來治療高血 壓時,發生心臟血管疾病的危險性較ACEI高,而且此結果是無法用血壓控制、血脂質、血 糖控制、或其他危險因子的差異來解釋的。雖然如此,我門在解讀鈣離子阻斷劑比ACEI有 較高的心臟血管疾病發生時還是要非常小心,因為在此二試驗中均沒有使用安慰劑的對照 組,因此此結果也可能解釋為兩類藥物都對心臟血管有保護作用,只是ACEI比鈣離子阻斷 劑的作用更好。即使此二臨床試驗的結果的確是因試驗所用的兩個鈣離子阻斷劑對心臟血 管的不良作用引起,我們也很難由現有的資料推論其他鈣離子阻斷劑具有相同的不良作用 。由目前的證據更不能將此結果推論到沒有糖尿病的病人身上。根據目前的資料有學者建 議將ACEI列為治療糖尿病病人發生高血壓的第一線使用藥物,而在ACEI、貝它阻斷劑,或 利尿劑使用無效後,才建議使用鈣離子阻斷劑。 斷劑。 |
英文摘要 | The safety of using calcium antagonists in treating diabetic patients with hypertension has been recently challenged. The Appropriate Blood pressure Control in Diabetes (ABCD) trial and the Fosinopril versus Amlodipine Cardiovascular Events Trial (FACET) are two prospective, randomized, controlled trial carried out in type 2 diabetic patients with hypertension, with the purpose of comparing the effectiveness of an angiotensin converting enzyme inhibitor (ACEI) and a calcium antagonist. In the ABCD trial and the FACET, enalapril versus nisoldipine and fosinopril versue amlodipine were used, respectively. Both of these studies monitored the cardiovascular outcomes as secondary endpoints. In the ABCD trail, after an average of 5 years of follow-up, the hypertensive component of the trial was terminated prematurely because a higher risk of fatal and non-fatal myocardial infarction was associated with the use of nisoldipine (adjusted RR=7.0, 95% CI=2.3-21.4). In the FACET, amlodipine was associated with a 2.04-fold higher risk (95% CI=1.05-3.84). Although the untoward effect of calcium antagonists in these two studies could not be explained by difference in blood pressure control, lipid profile, diabetes control, or other measured risk factors, the interpretation of the results should be cautious because there was no placebo control group in the studies. The untoward effect of calcium antagonists observed while compared to an ACEI could be either due to a better protective effect of ACEI than calcium antagonist, or a truly detrimental effect of calcium antagonists. Current data do not favor that the untoward influence of calcium antagonist is a class effect and an extension of the interpretation to patients without diabetes is not valid. Based on the currently available evidence, it is recommended that ACEI could be used as a first-line antihypertensive agent in diabetic patients, and that calcium antagonists should better be used only when ACEI, beta-blockers, and diuretics are unsuccessful. (J Intern Med Taiwan 1999;10: 39-143) |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。