Objective To assess the effectiveness and safety of one kind of ACEI—Ramipril, for providing proofs for clinical implement and we also tried to explore the practical method of evidence-based drug assessment. Method By using the methods and principles of systematic review (SR), and health technology assessment (HTA), we searched Medline and Cochrane Library, together with related materials provided by pharmaceutics and collected all the published clinical research reports on Ramipril. Based on principles of SR and HTA, we assessed all the included reports comprehensively. Results We totally collected 214 articles about Ramipril, in which there were 18 articles meeting the inclusion criteria and 31 139 patients were enrolled in these studies. The research contents include: hypertension, diabetes mellitus, heart failure, myocardial infarction, nephropathy and secondary prevention for cardio-cerebral vascular disease. Conclusion According to our clinical evidence assessment, Ramipril is an effective, safe and easy to take drug and is worthy to spread.
Objective To evaluate the clinical effectiveness, safety, cost-effectiveness of eight angiotensin converting enzyme inhibitors (ACEIs) in order to provide evidence for adjustment of Essential Drug List in China. Method Collecting all clinical trials by searching Medline, Cochrane Library, Embase and Chinese Biomedical Database and conducting critical appraisal. High quality randomized controlled trials and systematic reviews were included to assess the effectiveness of ACEIs. Non-randomized controlled trials were also included to evaluate the safety and cost-effectiveness. Results New generation of ACEIs are better than enalapril and captopril in antihypertension and endurance. Meta-analysis showed that T/P ratio was less than 50% in prindopril, benazepril and captopril. Enalapril and captopril had the most adequate evidence in the treatment of chronic heart failure. The effects of lisinopril, prindopril, benazepril and cilazapril positive influence on heart failure were assessed by surrogates. Captopril, lisinopril could reduce the total death rate of acute period (during 36 hours of AMI). Enalapril, captopril, ramipril and prindopril had the effect of heart protection in late period of AMI (3 days after AMI). Only ramipril, lisinopril and prindopril had evidence to support the protective effect on cerebral vessels. The available evidence, though not adequate, showed all the ACEIs except benazepril could diminish proteinuria and delay the renal failure. The new generations of ACEIs were similar in adverse reactions to enalapril and captopril, while incidences were lower than enalapril and captopril. Few evidence on cost-effectiveness of ACEIs were identified. The available evidence showed enalapril was cost-effective in treating heart failure. However, it compromised to lisinopril. The studies on ethics were not available. Conclusions It was difficult to generally rank the eight ACEIs according to available evidence. Not all eight ACEIs had adequate evidence in organs protection. It was suggested that clinicians should select ACEIs with adequate evidence to treat patients on states.
ObjectiveTo systematically review the association between angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) therapy and digestive system neoplasms.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were searched from inception to February 2017 to collect studies about ACEIs/ARBs therapy and risk of digestive system neoplasms or survival of digestive system neoplasms patients. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, then meta-analysis was performed using Stata 12.0 software.ResultsA total of 21 articles including 32 studies were included. The results of meta-analysis showed that ACEIs/ARBs therapy could reduce the risk of colorectal cancer (OR=0.92, 95%CI 0.86 to 0.99, P=0.023), but there were no relationships between ACEIs/ARBs therapy and the risk of liver cancer or gastric cancer. ACEIs/ARBs therapy could improve the survival of colorectal cancer patients (HR=0.79, 95%CI 0.63 to 0.98, P=0.031), but there was no association between ACEIs/ARBs therapy and the survival of pancreatic cancer patients (HR=0.75, 95%CI 0.50 to 1.13, P=0.165).ConclusionACEIs/ARBs therapy may reduce the risk of colorectal cancer, as well as improve the survival of colorectal cancer patients, but there are no significant relationships between ACEIs/ARBs therapy and the risk or the survival of other digestive system neoplasms, such as liver cancer, gastric cancer and pancreatic cancer. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo systematically review the impact of ACEI/ARB (angiotensin converting enzyme inhibitor/ angiotensin receptor antagonist) treatment on the clinical outcomes of Chinese patients with COVID-19 infections. MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, and VIP databases were electronically searched to collect cohort studies on the impact of the treatment with ACEI/ARB on the clinical outcomes of Chinese patients with COVID-19 infections from January 2020 to January 2022. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 17 cohort studies involving 4 912 subjects were included. The results of meta-analysis showed that patients who were prescribed ACEI/ARB had shorter hospital stays (SMD=−0.28, 95%CI −0.46 to −0.11, P=0.002) and a lower mortality rate (OR=0.47, 95%CI 0.36 to 0.62, P<0.000 01) than patients who did not take ACEI/ARB. ConclusionCurrent evidence shows that the use of ACEI/ARB drugs can improve the clinical prognosis of Chinese patients with COVID-19 infections. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
We correct some misunderstandings of hypertension therapy and update the knowledge of hypertensive drugs by reviewing the progress of evidence-based research of hypertension in 2004.