Ramipril可以使致命性腦中風的危險降低61%

高危險患者,應該不論其血壓程度如何,都應該使用這種藥物

  2002年3月21日──3月23日的《British Medical Journal》雜誌報導的一項雙盲隨機試驗中,血管緊縮素轉換脢(ACE)抑制劑ramipril相對於安慰劑,可以使致命性腦中風的危險降低61%。

  及其在Heart Outcomes Prevention Evaluation (HOPE)研究中的同事寫道:「腦中風高危險患者,不論其初始血壓如何,都應該在採用其他預防性治療措施,例如:降壓藥以及阿司匹林治療之外,應採用ramipril治療。」

  HOPE試驗的研究人員對9,297位55歲以上的腦中風高危險患者,隨機進行ramipril或者安慰劑組治療,對他們平均追蹤四年半,且每半年追蹤一次。

  採用ramipril治療的患者,血壓平均降低3.8/2.8 mmHg,與安慰劑組相比,ramipril治療組各種類型的腦中風的發生危險降低了32%,致命性腦中風的發生危險降低了61%。採用治療的患者,發生精神或者功能性損傷的患者數目,顯著性減少。

  由於在發達國家中,腦中風是發達國家致殘的首要原因,因此即使其致殘能力的中等程度的下降,也是具有整體意義的。作者寫道:「腦中風高危患者中,像ramipril這樣的ACE抑制劑的廣泛使用,很有可能會對公共衛生產生重要影響。」

  Aventis藥業,AstraZeneca,King醫藥,以及NEGMA醫藥,為此次研究提供資助。

Ramipril Reduces Fatal Stroke Risk by 61%

Should Be Given to High-Risk Patients Regardless of BP

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

March 21, 2002 -- In a double-blind, randomized trial reported in the March 23 issue of the British Medical Journal, the angiotensin-converting enzyme (ACE) inhibitor ramipril reduced the risk of fatal stroke by 61% compared with placebo.

"Patients who are at high risk of stroke should be treated with ramipril, irrespective of their initial blood-pressure levels and in addition to other preventive treatments such as blood pressure lowering agents or aspirin," write Jackie Bosch and colleagues from the Heart Outcomes Prevention Evaluation (HOPE) study.

The HOPE investigators assigned 9,297 patients aged 55 or over and at high risk of stroke to either ramipril or placebo, and followed them at six-month intervals for an average of four-and-a-half years.

Mean reduction in blood pressure was 3.8/2.8 mmHg in patients on ramipril. Compared with the placebo group, the risk of any stroke was reduced by 32% in the ramipril group, and the risk of fatal stroke was reduced by 61%. Significantly fewer patients on ramipril had mental or functional impairment.

"As stroke is the leading cause of disability in developed countries, even moderate decreases in disability would be of global importance," the authors write. "Widespread use of an ACE inhibitor such as ramipril in patients at high risk of stroke is likely to have a major impact on public health."

Aventis Pharma, AstraZeneca, King Pharmaceuticals, and NEGMA Pharmaceuticals provided funding for this study.

© 2002 WebMD Inc. All rights reserved.

    
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