BLOOD-PRESSURE, STROKE, AND CORONARY HEART-DISEASE .2. SHORT-TERM REDUCTIONS IN BLOOD-PRESSURE - OVERVIEW OF RANDOMIZED DRUG TRIALS IN THEIR EPIDEMIOLOGIC CONTEXT
BLOOD-PRESSURE, STROKE, AND CORONARY HEART-DISEASE .2. SHORT-TERM REDUCTIONS IN BLOOD-PRESSURE - OVERVIEW OF RANDOMIZED DRUG TRIALS IN THEIR EPIDEMIOLOGIC CONTEXT
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DOI：
10.1016/0140-6736(90)90944-z
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发表时间：
1990-04-07
期刊：
影响因子：
168.9
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
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作者：
COLLINS, R;PETO, R;HENNEKENS, CH
有14项抗高血压药物（主要是利尿剂或β受体阻滞剂）的无混杂随机试验：总共37,000名受试者，平均治疗持续时间5年，平均舒张压（DBP）差异5-6毫米汞柱。在前瞻性观察研究中，日常 DBP 5-6 mm Hg 的长期差异与中风减少约 35-40% 和冠心病 (CHD) 减少约 20-25% 相关。对于那些在试验中死亡的患者，DBP 差异仅持续 2-3 年，但概览表明血管死亡率显着降低 (2p < 0.0002)；非血管死亡率似乎没有变化。中风减少了 42% SD 6（95% 置信区间 33-50%；289 例与 484 例事件，2p < 0.0001），这表明几乎所有流行病学预期的中风减少都迅速出现。 CHD 减少了 14% SD 5（95% CI 4-22%；671 例与 771 例事件，2p < 0.01），表明流行病学预期的 CHD 减少的一半多一点出现得很快。虽然这种显着的冠心病减少可能是值得的，但在大多数情况下，其大小仍然是不确定的（尽管心肌梗塞后使用β受体阻滞剂具有显着的益处）。因此，目前，足够高的中风风险（可能是由于年龄、血压，或者特别是脑血管疾病史）可能是抗高血压治疗的最明确指征。
There are 14 unconfounded randomised trials of antihypertensive drugs (chiefly diuretics or beta-blockers): total of 37,000 individuals, mean treatment duration 5 years, mean diastolic blood pressure (DBP) difference 5-6 mm Hg. In prospective observational studies, a long-term difference of 5-6 mm Hg in usual DBP is associated with about 35-40% less stroke and 20-25% less coronary heart disease (CHD). For those dying in the trials, the DBP difference had persisted only 2-3 years, yet an overview showed that vascular mortality was significantly reduced (2p < 0.0002); non-vascular mortality appeared unchanged. Stroke was reduced by 42% SD 6 (95% confidence interval 33-50%; 289 vs 484 events, 2p < 0.0001), suggesting that virtually all the epidemiologically expected stroke reduction appears rapidly. CHD was reduced by 14% SD 5 (95% CI 4-22%; 671 vs 771 events, 2p < 0.01), suggesting that just over half the epidemiologically expected CHD reduction appears rapidly. Although this significant CHD reduction could well be worthwhile, its size remains indefinite for most circumstances (though beta-blockers after myocardial infarction are of substantial benefit). At present, therefore, a sufficiently high risk of stroke (perhaps because of age, blood pressure, or, in particular, history of cerebrovascular disease) may be the clearest indication for antihypertensive treatment.