OBJECTIVE:To review the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in the treatment of Raynaud's phenomenon (RP). DATA SOURCES:Biomedical literature was accessed through July 2006 via PubMed, the Iowa Drug Information System (IDIS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus. PubMed database terms included Raynaud's disease, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor blockers [pharmacological action]; IDIS terms included hypotensive agents-ace inhib 24080200, raynaud's syndrome 443.0, and hypotensive agents-angioten II 24080400; and CINAHL Plus terms included Raynaud's disease, angiotensin-converting enzyme inhibitors, losartan, and irbesartan. STUDY SELECTION AND DATA EXTRACTION:All clinical trials published in English that reported both subjective and objective outcomes of efficacy were reviewed. DATA SYNTHESIS:Several small, short-term studies have evaluated captopril, enalapril, and losartan in the treatment of RP. The studies of ACE inhibitors have found conflicting results in their ability to improve digit blood flow and reduce both frequency and severity of RP attacks. Two studies have focused on the use of losartan for RP treatment, with both finding a statistically significant reduction in attacks and one showing improvement in symptoms of RP in comparison with the commonly utilized calcium-channel blocker, nifedipine. Most of the studies were short term (< or =12 wk) and included a limited number of patients (<60). CONCLUSIONS:ACE inhibitors and ARBs may provide some minor benefits in the relief of RP, although no definite evidence exists to suggest that they are superior to traditionally used treatments such as calcium-channel blockers. Larger, randomized controlled trials of longer duration are needed to compare the effectiveness of ACE inhibitors and ARBs with conventional treatment.

译文

目的:探讨血管紧张素转换酶(ACE)抑制剂和血管紧张素II受体阻滞剂(ARBs)在治疗雷诺现象(RP)中的应用。
数据来源:截至2006年7月,通过PubMed,爱荷华州药物信息系统(IDIS)和护理和专职健康文献累积索引(CINAHL)Plus获得了生物医学文献。 PubMed数据库中的术语包括雷诺氏病,血管紧张素转换酶抑制剂和血管紧张素II 1型受体阻滞剂[药理作用]。 IDIS术语包括降压药-王牌吸脂24080200,雷诺氏综合症443.0和降压药-血管紧张素II 24080400; CINAHL Plus术语包括雷诺氏病,血管紧张素转换酶抑制剂,氯沙坦和厄贝沙坦。
研究选择和数据提取:审查了所有以英文发表的报告疗效的主观和客观结果的临床试验。
数据综合:几个小型的短期研究评估了卡托普利,依那普利和氯沙坦在RP的治疗中。 ACE抑制剂的研究发现,在改善手指血流,降低RP发作的频率和严重性方面的能力存在矛盾的结果。有两项研究着眼于氯沙坦用于RP的治疗,与常用的钙通道阻滞剂硝苯地平相比,两者均发现统计学上显着降低发作次数,并且一项显示RP症状有所改善。大多数研究是短期的(<或= 12 wk),并且包括数量有限的患者(<60)。
结论:ACE抑制剂和ARBs在缓解RP方面可能会产生一些小的益处,尽管尚无确切证据表明它们优于传统使用的治疗方法,例如钙通道阻滞剂。需要比较长时间的大型随机对照试验,以比较ACE抑制剂和ARB与常规治疗的有效性。

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