188bet在线平台网址 肾病成人用降压药物的疗效和安全性尚存在争议，因此欧洲学者们对此进行了研究。结果表明，没有降压策略可延长188bet在线平台网址 肾病成人患者的生存。肾素血管紧张素转换酶抑制剂(ACEI)和血管紧张素拮抗剂(ARB)单独用药或联合用药是对终末期肾病的最有效方法;但需权衡ACEI和ARB联合治疗的利弊，即患者获益是否超过潜在高钾血症和急性肾损伤风险。论文近期在线发表于《柳叶刀》(The Lancet)杂志。

        该研究为全球随机对照试验的荟萃分析，研究者系统地检索了2014年1月份以前发表于电子数据库的研究，这些研究均在188bet在线平台网址 和肾病成人患者中对比了口服降压药物的疗效和安全性。主要终点为为全因死亡率和终末期肾病，还评估了次要安全指标和心血管转归。研究者们进行了随机效应网络荟萃分析，以评估主要和次要转归，并计算比值比(OR)或标化的95%置信区间(CI)平均差异。将所有药物与安慰剂相比下的效果进行分类。

        结果共包含43256例受试者的157项试验纳入了该研究，多为2型188bet在线平台网址 和慢性肾病患者。在减少全因死亡方面，没有药物治疗方案比安慰剂更加有效。但与安慰剂相比，接受ARB和ACEI双重治疗(OR0.62)或ARB单药治疗(OR0.77)后的受试者患终末期肾病的可能性明显较少。在所有干预方法中，因估计的高钾血症或急性肾损伤呈边界性增加，虽然ARB和ACEI联合治疗方案处于最低，但没有治疗方案明显增加高钾血症或急性肾损伤。

        参考文献：Suetonia C Palmer,etal.The Lancet.Volume 385, No. 9982, p2047–2056, 23 May 2015

Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: a network meta-analysis

Background
The comparative efficacy and safety of pharmacological agents to lower blood pressure in adults with diabetes and kidney disease remains controversial. We aimed to investigate the benefits and harms of blood pressure-lowering drugs in this population of patients.
Methods
We did a network meta-analysis of randomised trials from around the world comparing blood pressure-lowering agents in adults with diabetic kidney disease. Electronic databases (the Cochrane Collaboration, Medline, and Embase) were searched systematically up to January, 2014, for trials in adults with diabetes and kidney disease comparing orally administered blood pressure-lowering drugs.Primary outcomes were all-cause mortality and end-stage kidney disease. We also assessed secondary safety and cardiovascular outcomes.We did random-effects network meta-analysis to obtain estimates for primary and secondary outcomes and we presented these estimates as odds ratios or standardised mean differences with 95% CIs.We ranked the comparative effects of all drugs against placebo with surface under the cumulative ranking (SUCRA) probabilities.
Findings
157 studies comprising 43 256 participants, mostly with type 2 diabetes and chronic kidney disease, were included in the network meta-analysis.No drug regimen was more effective than placebo for reducing all-cause mortality.However, compared with placebo, end-stage renal disease was significantly less likely after dual treatment with an angiotensin-receptor blocker (ARB) and an angiotensin-converting-enzyme (ACE) inhibitor (odds ratio 0•62, 95% CI 0•43–0•90) and after ARB monotherapy (0•77, 0•65–0•92). No regimen significantly increased hyperkalaemia or acute kidney injury, although combinedACE inhibitor and ARB treatment had the lowest rank among all interventions because of borderline increases in estimated risks of these harms (odds ratio 2•69, 95% CI 0•97–7•47 for hyperkalaemia; 2•69, 0•98–7•38 for acute kidney injury).
Interpretation
No blood pressure-lowering strategy prolonged survival in adults with diabetes and kidney disease. ACE inhibitors and ARBs, alone or in combination, were the most effective strategies against end-stage kidney disease. Any benefits of combined ACE inhibitor and ARB treatment need to be balanced against potential harms of hyperkalaemia and acute kidney injury.