基于性别不同的慢性心衰患者使用beta受体阻滞剂获益的meta分析.docVIP

 n Benefits of beta-blockers according to varying male proportions of study patients:a meta-analysis of randomized,double-blinded,placebo controlled clinical trials 5 10 15 20 25 30 35 40 45 HE Yongming, YANG Xiangjun, ZHAO Xin, CHENG Xujie, XU Haifeng, QIAN Yunxia, LI Xun* (The 1st Afilliated Hospital of Soochow University, JiangSu SuZhou 215006) Abstract: Aims: In patients with heart failure (HF), beta-blockers reduce mortality. This meta-analysis aimed at clarifying the true beneficial effects of the 3 beta-blockers recommended by the guideline on mortality. It’s also not known whether the beneficial effects of the beta-blockers were associated with the differing male proportions of study patients. Methods: randomized, placebo controlled clinical trials were included if they evaluated the beneficial effects of the three b-blockers on mortality and on hospital admissions on an intention-to-treat basis, and lasted at least 3 months. Results: Twenty-eighty trials with 14,829 patients were included. The beta-blockers significantly reduced all cause mortality by 29.6%, cardiac death by 29.8%, sudden death by 49.4%, respectively. The magnitude of benefits of beta-blockers in HF patients was increased with the increased male proportion. A similar magnitude of reduction in all cause mortality was observed among the three b blockers. A trend toward to reduced cardiac death was observed among the three b blockers, but only in bisoprolol was this statistically different (RR, 0.72; 95%CI, [0.59-0.87]). Metoprolol was significantly superior to carvedilol (P=0.008) or bisoprolol (P=0.034) in reduced sudden death. Conclusions: In patients with HF, the 3 commonly used beta-blockers significantly reduced mortality. Greater benefits of beta-blockers were observed in the higher male proportion studies. The metoprolol was significantly superior to carvedilol or bisoprolol in reduced sudden death. Additional trials are required to determine whether the benefits of beta-blockers