Primary prevention with metoprolol in patients with hypertension. Mortality results from the MAPHY study.
Primary prevention with metoprolol in patients with hypertension. Mortality results from the MAPHY study.
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高血压患者使用美托洛尔进行一级预防。
DOI：
10.1001/jama.1988.03720130040027
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Göran Berglund
中科院分区：
文献类型：
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作者：
J. Wikstrand;Ingrid Warnold;Gunnar L. Olsson;Jaakko Tuomilehto;Dag Elmfeldt;Göran Berglund
目前针对 40 至 64 岁白人男性的一级预防研究试图调查作为初始抗高血压治疗的 β 受体阻滞剂是否比噻嗪类利尿剂能更大程度地降低总死亡率。患者被随机分配至美托洛尔（n = 1609、8110 患者年）或噻嗪类利尿剂（n = 1625、8070 患者年）。中位随访时间为 4.2 年。美托洛尔的平均剂量为 174 mg/d，噻嗪类利尿剂的平均剂量为 46 mg/d 氢氯噻嗪或 4.4 mg/d 苯氟噻嗪。使用固定的治疗方案实现了相同的血压控制。美托洛尔的总死亡率显着低于噻嗪类利尿剂，因为冠心病和中风的死亡人数较少。随机接受美托洛尔治疗的吸烟者的总死亡率也显着降低。使用美托洛尔治疗的患者所表现出的益处似乎对临床实践具有重要意义。
The present study of primary prevention in white men aged 40 to 64 years attempts to investigate whether a beta-blocker given as initial antihypertensive treatment would lower total mortality to a greater extent than thiazide diuretics. Patients were randomized to metoprolol (n = 1609, 8110 patient-years) or a thiazide diuretic (n = 1625, 8070 patient-years). The median follow-up time was 4.2 years. The mean dose of metoprolol was 174 mg/d, and of thiazide diuretics, 46 mg/d of hydrochlorothiazide or 4.4 mg/d of bendroflumethiazide. Identical control of blood pressure was achieved using a fixed therapeutic schedule. Total mortality was significantly lower for metoprolol than for thiazide diuretics because of fewer deaths from coronary heart disease and stroke. Total mortality was also significantly lower in smokers randomized to metoprolol. The benefit demonstrated in patients treated with metoprolol seems to have important implications for clinical practice.