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目的 :评价血管紧张素转换酶抑制剂 (ACEI)雷米普利 (ramipril)在脑卒中二级预防中的作用。试验设计 :随机对照 2× 2析因设计。组织 :19个国家的 2 67家医院。入选者 :92 97例患者 ,均有血管疾病或合并有一个危险因素的糖尿病患者 ,随访 4 5年。其为HOPE试验的一个组成部分。观察指标 :脑卒中 (有条件时 ,由CT或MRI证实 )、短暂脑缺血发作 (TIA)、认知功能障碍。在患者入选时、2年时及终点时记录血压。结果 :应用雷米普利使血压轻度下降 (平均收缩压降低 3 8mmHg,舒张压降低 2 8mmHg)。应用雷米普利组比安慰剂组脑卒中相对危险度下降 3 2 % (15 6比 2 2 6) ,致死性脑卒中下降 5 1%(17比 44 )。不管患者的基线血压水平高低、是否应用其他药物 ,以及有无脑卒中史、冠心病、外周动脉疾病、糖尿病或高血压 ,应用雷米普利受益是一致的。雷米普利组大脑认知或功能障碍者明显少于安慰剂组。结论 :雷米普利尽管使血压轻度降低 ,却使高危患者的脑卒中发生率明显下降。
AIM: To evaluate the role of angiotensin converting enzyme inhibitor (ACEI) ramipril in secondary prevention of stroke. Experimental Design: Randomized Controlled 2 × 2 Factorial Design. Organization: 2 67 hospitals in 19 countries. Enrolled: 92 97 patients, all with vascular disease or with a risk factor in patients with diabetes, followed up 45 years. It is an integral part of the HOPE trial. OUTCOME MEASURES: Stroke (confirmed by CT or MRI, when available), transient ischemic attack (TIA), cognitive impairment. Blood pressure was recorded at the time of enrollment, at 2 years and at the end of the day. RESULTS: Ramipril was used to moderately decrease blood pressure (mean systolic BP of 38 mmHg and diastolic BP of 28 mmHg). The relative risk of stroke in the ramipril group was reduced by 32% (15 6 vs 226) and fatal stroke by 5 1% (17 vs 44) compared with placebo. Regardless of the patient’s baseline blood pressure levels, whether other medications are used, and whether there is a history of stroke, coronary heart disease, peripheral arterial disease, diabetes, or hypertension, the benefit of ramipril is consistent. Brain ramipril group cognitive or dysfunction was significantly less than the placebo group. Conclusion: Although ramipril mildly reduced blood pressure, the incidence of stroke in high-risk patients decreased significantly.