Reply to: Should physicians aggressively treat pre-hypertension?
Reply to: Should physicians aggressively treat pre-hypertension?
复制标题
回复：医生应该积极治疗高血压前期吗？
DOI：
10.1016/j.amjmed.2009.01.007
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Havranek,EdwardP
中科院分区：
文献类型：
--
作者：
Havranek,EdwardP
我们感谢加勒特博士对我们的工作表现出的兴趣。她指出，尽管我们将几项比较描述为没有统计学意义，但我们报告的按种族和民族归因于左心室肥厚的死亡率的差异幅度表明，我们的发现对整个人群的影响可能相当大。我们承认，我们保守地解读了我们的结果，但同意我们的发现的影响可能比我们暗示的更大。尽管我们的样本可能看起来足够大，第二类错误的可能性很低，但将其分为三个种族/民族群体限制了权力。Garrett还提出了一个有趣的问题，即更广泛地使用超声心动图来检测高血压前期受试者的LVH。我们的研究没有提供可以直接解决这个问题的结果，但它表明心电图学在这种情况下可能是有用的，因为它可以预测死亡率，价格低廉，而且可以广泛获得。心电图学是否应该作为高血压前期患者初步评估的一部分值得未来考虑；高血压前期和Novacode评分高于我们之前描述的阈值的受试者1可能会从药物治疗中受益，而不需要等待进展到明显的高血压。
We appreciate the interest Dr. Garrett has shown in our work. She points out that while we described several comparisons as being not statistically significant, the magnitude of the differences we reported in mortality attributable to LVH by race and ethnicity suggests the population-wide impact of our findings might be quite large. We acknowledge that we interpreted our results conservatively but agree the implications of our findings might be greater than we implied. Although our sample might appear to be large enough to have low likelihood of a type II error, dividing it into three racial/ethnic groups limits power.Dr. Garrett also raises the interesting question of more widespread use of echocardiography to detect LVH in subjects with pre-hypertension. Our study does not provide results that can address this question directly, but it suggests that electrocardiography may be useful in this situation given that it is predictive of mortality, is inexpensive, and is widely available. Whether electrocardiography should be part of the initial evaluation of patients with prehypertension is worthy of future consideration; subjects with pre-hypertension and Novacode scores greater than the thresholds we have previously described1 might benefit from drug treatment without waiting for progression to overt hypertension.