Адаптированный перевод и публикация статьи осуществлены с разрешения Американской коллегии кардиологов (American College of Cardiology) под контролем экспертов РКО. Статья G. Savarese, P. Costanzo, J.G.F. Cleland, E. Vassallo, D. Ruggiero, G. Rosano, P. Perrone-Filardi «A Meta-Analysis Reporting Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure» впервые опубликована в журнале J Am Coll Cardiol 2013;61(2):131-42; http://dx.doi.org/10.1016/j.jacc.2012.10.011 Цель. Оценить влияние ингибиторов ангиотензинпревращающего фермента (ИАПФ) и блокаторов рецепторов ангиотензина (БРА) на объединенный исход, включающий сердечно-сосудистую смерть, инфаркт миокарда (ИМ) и инсульт, а также на смертность от всех причин, возникновение сердечной недостаточности (СН) и впервые выявленного сахарного диабета (СД) в группе высокого риска у пациентов без СН.Введение. ИАПФ уменьшают частоту сердечно-сосудистых событий в группе больных с высоким сердечно-сосудистым риском без СН, в то время как эффект БРА является менее определенным.Материал и методы. В мета-анализ было включено 26 рандомизированных исследований, сравнивающих БРА и ИАПФ с плацебо у 108212 пациентов без СН. Проанализирован риск объединенного исхода, смертности от всех причин, возникновения СН и впервые выявленного СД.Результаты. ИАПФ достоверно снижали риск объединенного исхода (отношение шансов [ОШ]: 0.830 [95% доверительный интервал (ДИ) 0,744-0,927], р=0,001), ИМ (ОШ:0,811 [95% ДИ 0,748-0,879], р<0,001), инсульта (ОШ: 0,796 [95% ДИ 0,682-0,928], р<0,004), смерти от всех причин (ОШ: 0,908 [95% ДИ 0,845-0,975], р=0,008), впервые возникшей СН (OШ: 0,789 [95% ДИ 0,686-0,908], р=0,001), и впервые выявленного СД (ОШ: 0,851 [95% ДИ 0,749-0,965], р<0,012). БРА достоверно снижали риск объединенного исхода (OШ: 0,920 [95% ДИ 0,869-0,975], р=0,005), инсульта (ОШ: 0.900 [95% ДИ 0,830-0,977], р=0,011), и впервые выявленного СД (ОШ: 0,855 [95% ДИ 0,798-0,915], р<0,001).Заключение. У пациентов с высоким сердечно-сосудистым риском без СН ИАПФ и БРА снижали риск объединенного исхода, включавшего смерть от сердечно-сосудистых причин, инфаркт миокарда и инсульт. ИАПФ также снижали риск смерти от всех причин, впервые возникшей СН, и впервые выявленного СД. Таким образом, БРА дают ценную возможность снижения сердечно-сосудистой заболеваемости и смертности у пациентов, у которых невозможно применение ИАПФ
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