本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.6774

摘要内容如下：

重要性

肾素-血管紧张素系统（RAS）阻滞剂对黑人心力衰竭和射血分数降低（HFREF）患者的疗效不如非黑人患者。

目的

确定RAS阻滞剂对患有HFREF的黑人患者和非黑人患者的心血管结局的影响是否不同。

数据源

截至2023年12月31日的MEDLINE和EMBASE数据库。

研究选择

随机试验研究RAS阻滞剂对成年HFREF患者心血管结局的影响，纳入黑人和非黑人患者。

数据提取与合成

根据系统评价和荟萃分析独立个人数据（PRISMA-IPD）报告指南的首选报告项目提取个体参与者数据。使用1阶段方法的混合效应模型来估计效应。

主要成果和措施

主要转归是因心衰或心血管死亡而首次住院。

结果

基于3项安慰剂对照RAS抑制剂单药治疗试验的主要分析包括8825名患者（9.9%为黑人）。黑人心衰患者的死亡率和住院率明显高于非黑人患者。RAS阻断剂与安慰剂的主要复合风险比（HR）在黑人患者中为0.84（95%CI，0.69-1.03），在非黑人患者中为0.73（95%CI，0.67-0.79）（相互作用P=.14）。黑人患者首次心衰住院的HR为0.89（95%CI，0.70-1.13），非黑人患者为0.62（95%CI，0.56-0.69）（P=0.006）。相反，心血管死亡的相应HR分别为0.83（95%CI，0.65-1.07）和0.84（95%CI，0.77-0.93）（P=0.99）。对于心衰和心血管死亡的总住院率，相应的比率分别为0.82（95%CI，0.66-1.02）和0.72（95%CI，0.66-0.80）（P=0.27）。支持性分析（包括2项在背景血管紧张素转换酶抑制剂治疗中加入血管紧张素受体阻滞剂的试验（n=16383））给出了一致的结果。

结论和相关性

在黑人和非黑人患者中，RAS阻断的死亡率获益相似。尽管在黑人患者中，RAS阻滞剂对HF住院的相对风险降低较小，但黑人患者的绝对获益与非黑人患者相当，因为黑人患者中这种结果的发生率更高。

英文原文如下：

Abstracts

Importance  Concerns have arisen that renin-angiotensin system (RAS) blockers are less effective in Black patients than non-Black patients with heart failure and reduced ejection fraction (HFrEF).

Objective  To determine whether the effects of RAS blockers on cardiovascular outcomes differ between Black patients and non-Black patients with HFrEF.

Data Sources  MEDLINE and Embase databases through December 31, 2023.

Study Selection  Randomized trials investigating the effect of RAS blockers on cardiovascular outcomes in adults with HFrEF that enrolled Black and non-Black patients.

Data Extraction and Synthesis  Individual-participant data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-analyses Independent Personal Data (PRISMA-IPD) reporting guidelines. Effects were estimated using a mixed-effects model using a 1-stage approach.

Main Outcome and Measure  The primary outcome was first hospitalization for HF or cardiovascular death.

Results  The primary analysis, based on the 3 placebo-controlled RAS inhibitor monotherapy trials, included 8825 patients (9.9% Black). Rates of death and hospitalization for HF were substantially higher in Black than non-Black patients. The hazard ratio (HR) for RAS blockade vs placebo for the primary composite was 0.84 (95% CI, 0.69-1.03) in Black patients and 0.73 (95% CI, 0.67-0.79) in non-Black patients (P for interaction = .14). The HR for first HF hospitalization was 0.89 (95% CI, 0.70-1.13) in Black patients and 0.62 (95% CI, 0.56-0.69) in non-Black patients (P for interaction = .006). Conversely, the corresponding HRs for cardiovascular death were 0.83 (95% CI, 0.65-1.07) and 0.84 (95% CI, 0.77-0.93), respectively (P for interaction = .99). For total hospitalizations for HF and cardiovascular deaths, the corresponding rate ratios were 0.82 (95% CI, 0.66-1.02) and 0.72 (95% CI, 0.66-0.80), respectively (P for interaction = .27). The supportive analyses including the 2 trials adding an angiotensin receptor blocker to background angiotensin-converting enzyme inhibitor treatment (n = 16 383) gave consistent findings.

Conclusions and Relevance  The mortality benefit from RAS blockade was similar in Black and non-Black patients. Despite the smaller relative risk reduction in hospitalization for HF with RAS blockade in Black patients, the absolute benefit in Black patients was comparable with non-Black patients because of the greater incidence of this outcome in Black patients.

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