Randomised trial of old and new antihypertensive drugs in elderly patients:: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study
Randomised trial of old and new antihypertensive drugs in elderly patients:: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study
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DOI：
10.1016/s0140-6736(99)10327-1
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发表时间：
1999-11-20
期刊：
影响因子：
168.9
通讯作者：
de Faire, U
中科院分区：
文献类型：
--
作者：
Hansson, L;Lindholm, LH;de Faire, U
背景：新的降压药的疗效一直受到质疑。方法我们对6614名70-84岁的高血压患者(血压收缩压大于或等于180 mm Hg，舒张压大于或等于105 mm Hg，或两者兼而有之)进行了前瞻性随机试验。患者随机分为常规降压药(阿替洛尔50 mg，美托洛尔100 mg，吲哚洛尔5 mg，或氢氯噻嗪25 mg加阿米洛利25 mg，每日1次)或新药(依那普利10 mg或赖诺普利10 mg，非洛地平2.5 mg或伊拉地平2~5 mg，每日1次)。我们评估了致命的中风、致命的心肌梗死和其他致命的心血管疾病。分析是根据治疗意图进行的。结果显示，所有治疗组的血压都有类似的下降。致命性中风、致命性心肌梗死和其他致命心血管疾病的主要联合终点在常规药物组2213名患者中有221名(每1000人年发生19.8起事件)，在新药组4401名患者中有438例(每1000人发生19.8起事件；相对风险0.99[95%可信区间0.84-1.16]，p=0.89)。460名服用常规药物的患者和887名服用新药的患者出现了致命和非致命中风、致命和非致命心肌梗死以及其他心血管死亡的联合终点(0.96[0.86-1.08]，p=0.49)。血压的降低对于预防心血管事件具有重要意义。
Background The efficacy of new antihypertensive drugs has been questioned. We compared the effects of conventional and newer antihypertensive drugs on cardiovascular mortality and morbidity in elderly patients.Methods We did a prospective, randomised trial in 6614 patients aged 70-84 years with hypertension (blood pressure greater than or equal to 180 mm Hg systolic, greater than or equal to 105 mm Hg diastolic, or both). Patients were randomly assigned conventional antihypertensive drugs (atenolol 50 mg, metoprolol 100 mg, pindolol 5 mg, or hydrochlorothiazide 25 mg plus amiloride 25 mg daily) or newer drugs (enalapril 10 mg or lisinopril 10 mg, or felodipine 2.5 mg or isradipine 2-5 mg daily). We assessed fatal stroke, fatal myocardial infarction, and other fatal cardiovascular disease. Analysis was by intention to treat.Findings Blood pressure was decreased similarly in all treatment groups. The primary combined endpoint of fatal stroke, fatal myocardial infarction, and other fatal cardiovascular disease occurred in 221 of 2213 patients in the conventional drugs group (19.8 events per 1000 patient-years) and in 438 of 4401 in the newer drugs group (19.8 per 1000; relative risk 0.99 [95% CI 0.84-1.16], p=0.89). The combined endpoint of fatal and non-fatal stroke, fatal and non-fatal myocardial infarction, and other cardiovascular mortality occurred in 460 patients taking conventional drugs and in 887 taking newer drugs (0.96 [0.86-1.08], p=0.49).Interpretation Old and new antihypertensive drugs were similar in prevention of cardiovascular mortality or major events. Decrease in blood pressure was of major importance for the prevention of cardiovascular events.