卒中是美国人死亡的第二主要死因(编者注：在中国是第一死因)，卒中独立危险因素——药物治疗高血压可显著降低卒中发生率。虽然既往荟萃研究显示，在减少卒中风险方面，不同种类的抗高血压药优于安慰剂，但哪种最有效尚不明。美国学者们对此进行了荟萃分析，结果表明，在所有抗高血压药物中，钙离子通道阻滞剂(CCB)在长期减少卒中发生方面最有效，而β受体阻滞剂与这种风险增加显著相关。

研究者们系统检索了在1999至2014年发表的有关抗高血压治疗对卒中一级和或二级预防的随机对照临床试验(RCT)，对比了五类降压药的效果，这五类药物包括血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、钙离子通道阻滞剂(CCB)和噻嗪样利尿剂(T-T LD)。

结果共纳入251853例患者，女性11.4%，平均年龄67.2±6.8岁。接受ACEI、ARB、ACEI/ARB、β受体阻滞剂、CCB和T-TLD治疗的患者数分别为52887、7278、60165、24099、 98950和68639例。平均随访时间为42.9 15个月。至研究结束时，每种抗高血压药物与其他所有抗高血压药物的总体卒中发生风险比值和计算得到的血压差异见下表。

相关文章公布于美国心脏学会科学年会（ACC2015）上。

原文

Long-Term Hypertensive Therapy and Stroke Prevention: A Meta-Analysis
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March 15, 2015, 9:45 - 10:30 AM
________________________________________
Disclosures
Faculty Disclosures
Authors
Bertrand Njume Mukete, Mark Cassidy, Keith Ferdinand, Thierry LeJemtel, Tulane University School of Medicine, New Orleans, LA, USA

Abstract
Background:
Stroke yearly produces about 6.7 million worldwide deaths as the second leading cause. Pharmacotherapy for hypertension, an independent stroke risk factor, significantly reduces incidence. Although prior meta-analyses demonstrate various antihypertensive classes are superior to placebo in reducing stroke risk, which class is most effective is unclear.
Methods:
A systematic MEDLINE search included only randomized antihypertension controlled clinical trials (RCT) published between 1999-2014 in adults with stroke as a primary or secondary outcome. Five classes compared against all others were: angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta-blockers (B-blocker), calcium channel blockers (CCB), thiazide-thiazide like diuretics (T-TLD). Among 17 RTCs with 30 comparative arms, risk ratio assessed effect size and a fix and random model calculated summary effect size.
Result:
Among 251,853 total patients (46 11.4% female; mean age 67.2+- 6.8 years), there were 52,887; 7,278; 60,165; 24,099; 98,950; and 68,639 patients in the ACEI, ARB, ACEI/ARB, B-blocker, CCB and T-TLD groups respectively. The mean follow-up was 42.9 15 months. The study end calculated class Blood Pressure difference and summary stroke risk ratio for each class versus all others is depicted (figure 1).
Conclusion:
Among all classes, CCBs were most effective long-term in reducing stroke incidence, whereas B-blockers were associated with significantly increased risk.

参考文献：Bertrand Njume Mukete,et al. Abstract Presented at: American College of Cardiology Scientific Session & Expo; March 15, 2015, 9:45 - 10:30 AM