Pharmacotherapy for mild hypertension
Pharmacotherapy for mild hypertension
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DOI：
10.1002/14651858.cd006742.pub2
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发表时间：
2012-01-01
影响因子：
1.4
通讯作者：
Gueyffier, Francois
中科院分区：
文献类型：
--
作者：
Diao, Diana;Wright, James M.;Gueyffier, Francois
背景既往无心血管事件或心血管疾病的人群是一级预防人群。治疗轻度高血压在一级预防患者中的益处和危害目前尚不清楚。本文回顾了现有的随机对照试验（RCT）的证据。量化抗高血压药物治疗对轻度高血压成人死亡率和发病率的影响（收缩压（BP）140-159 mmHg和/或舒张压90-99 mmHg）和无心血管疾病。（2011年，第1期）、MEDLINE（1948年至2011年5月）、EMBASE（1980年至2011年5月）和文章参考文献列表。检索科克伦系统评价数据库和有效性评价摘要数据库（DARE），以获得截至2011年底的抗高血压药物治疗与安慰剂或无治疗试验相比的既往评价和荟萃分析。选择标准：至少持续1年的RCT。总心血管事件（CVS）和由于不良反应而退出研究。主要结果在11项随机对照试验中，有4项被纳入本综述，共有8，912名受试者。与安慰剂相比，抗高血压药物治疗4 - 5年未降低总死亡率（RR 0.85，95% CI 0.63，1.15）。在7，080例受试者中，与安慰剂相比，抗高血压药物治疗并未减少冠心病（RR 1.12，95% CI 0.80，1.57）、卒中（RR 0.51，95% CI 0.24，1.08）或总心血管事件（RR 0.97，95% CI 0.72，1.32）。由于药物治疗引起的不良反应的死亡率增加（RR 4.80，95%CI 4.14，5.57），ARR 9%。作者的结论：在成人轻度高血压（收缩压140-159 mmHg和/或舒张压90-99 mmHg）的一级预防中使用抗高血压药物并不能降低死亡率或发病率。治疗导致9%的患者因不良反应而停止治疗。在这一流行人群中需要更多的随机对照试验，以了解治疗的益处是否超过危害。
BackgroundPeople with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomised controlled trial (RCT) evidence.ObjectivesPrimary objective: To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP) 140-159 mmHg and/or diastolic BP 90-99 mmHg) and without cardiovascular disease.Search methodsWe searched CENTRAL (2011, Issue 1), MEDLINE (1948 to May 2011), EMBASE (1980 to May 2011) and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE) were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011.Selection criteriaRCTs of at least 1 year duration.Data collection and analysisThe outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and withdrawals due to adverse effects.Main resultsOf 11 RCTs identified 4 were included in this review, with 8,912 participants. Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15). In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57), stroke (RR 0.51, 95% CI 0.24, 1.08), or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32). Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95% CI 4.14, 5.57), ARR 9%.Authors' conclusionsAntihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.