The prevention of dementia with antihypertensive treatment
The prevention of dementia with antihypertensive treatment
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DOI：
10.1001/archinte.162.18.2046
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发表时间：
2002-10-14
影响因子：
--
通讯作者：
Birkenhäger, WH
中科院分区：
文献类型：
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作者：
Forette, F;Seux, ML;Birkenhäger, WH
背景：欧洲双盲、安慰剂对照收缩期高血压 (Syst-Eur) 试验于 1997 年 2 月结束后，为随机患者提供活性研究药物以进行进一步的观察。 目的： 完善抗高血压治疗对痴呆发生率的长期影响的估计。 方法： 符合条件的患者没有痴呆且年龄至少 60 岁。他们入院时的收缩压为 160 至 219 毫米汞柱，舒张压低于 95 毫米汞柱。积极治疗组随机分组后立即开始抗高血压治疗，但对照组患者仅在双盲试验结束后才开始。治疗包括尼群地平（10-40 毫克/天），可能添加马来酸依那普利（5-20 毫克/天）、氢氯噻嗪（12.5-25 毫克/天）或两种附加药物。 结果：中位随访时间从双盲试验中的 2.0 年增加到总体 3.9 年。痴呆症发病率翻了一番，从 32 例增加到 64 例，其中 41 例患有阿尔茨海默病。在整个随访过程中，1417 名对照患者的收缩压/舒张压比随机接受积极治疗的 1485 名受试者高 7.0/3.2 mm Hg。上次检查时，血压差仍为4.2/2.9毫米汞柱； 48.1%、26.4% 和 11.4% 的对照患者服用尼群地平、依那普利和/或氢氯噻嗪，而在积极治疗组中，这些比例分别为 70.2%、35.4% 和 18.4%。与对照组相比，长期抗高血压治疗可将痴呆风险降低 55%，从每 1000 患者年 7.4 例降至 3.3 例（43 例 vs 21 例，P
Background: After the double-blind, placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial ended in February 1997, randomized patients were offered active study medication for a further period of observation.Objective: To refine the estimates of the long-term effects of antihypertensive therapy on the incidence of dementia.Methods: Eligible patients had no dementia and were at least 60 years old. Their systolic blood pressure at entry was 160 to 219 mm Hg, with diastolic blood pressure below 95 mm Hg. Antihypertensive therapy was started immediately after randomization in the active treatment group, but only after termination of the double-blind trial in the control patients. Treatment consisted of nitrendipine (10-40 mg/d), with the possible addition of enalapril maleate (5-20 mg/d), hydrochlorothiazide (12.5-25 mg/d), or both add-on drugs.Results: Median follow-up increased from 2.0 years in the double-blind trial to 3.9 years overall. The incidence of dementia doubled from 32 to 64 cases, 41 of whom had Alzheimer disease. Throughout follow-up, systolic/diastolic blood pressure was 7.0/3.2 mm Hg higher in the 1417 control patients than in the 1485 subjects randomized to active treatment. At the last examination, the blood pressure difference was still 4.2/2.9 mm Hg; 48.1%, 26.4%, and 11.4% of the control patients were taking nitrendipine, enalapril, and/or hydrochlorothiazide, whereas in the active treatment group these proportions were 70.2%, 35.4%, and 18.4%, respectively. Compared with the controls, long-term antihypertensive therapy reduced the risk of dementia by 55%, from 7.4 to 3.3 cases per 1000 patient-years (43 vs 21 cases, P