Treatment of hypertension in patients 80 years of age or older
Treatment of hypertension in patients 80 years of age or older
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DOI：
10.1056/nejmoa0801369
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发表时间：
2008-05-01
影响因子：
158.5
通讯作者：
Bulpitt, Christopher J.
中科院分区：
文献类型：
--
作者：
Beckett, Nigel S.;Peters, Ruth;Bulpitt, Christopher J.
背景：80岁或以上高血压患者的治疗是否有益尚不清楚。有人认为，抗高血压治疗可能会降低中风的风险，尽管可能会增加死亡的风险。方法：我们随机分配3845例来自欧洲，中国，澳大拉西亚，突尼斯谁是80岁或以上，并有一个持续的收缩压为160毫米汞柱或以上，接受利尿剂吲达帕胺（缓释，1.5毫克）或匹配的安慰剂。如有必要，加入血管紧张素转换酶抑制剂培哚普利（2或4 mg）或匹配的安慰剂，以达到150/80 mm Hg的目标血压。主要终点是致命性或非致命性stroke.Results：积极治疗组（1933例）和安慰剂组（1912例）匹配良好（平均年龄，83.6岁;平均血压，而坐着，173.0/90.8毫米汞柱）; 11.8%有心血管疾病史。中位随访时间为1.8年。2年时，活性药物治疗组的平均坐位血压比安慰剂组低15.0/6.1 mm Hg。在意向治疗分析中，积极治疗与致死性或非致死性卒中发生率降低30（95%置信区间[CI]，-1至51; P=0.06），卒中死亡率降低39%（95% CI，1 - 62; P=0.05），全因死亡率降低21%（95% CI，4 - 35; P=0.02），心血管原因死亡率降低23%（95%CI，-1至40; P=0.06），心力衰竭发生率降低64%（95%CI，42至78; P
Background: Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear. It has been suggested that antihypertensive therapy may reduce the risk of stroke, despite possibly increasing the risk of death.Methods: We randomly assigned 3845 patients from Europe, China, Australasia, and Tunisia who were 80 years of age or older and had a sustained systolic blood pressure of 160 mm Hg or more to receive either the diuretic indapamide (sustained release, 1.5 mg) or matching placebo. The angiotensin-converting-enzyme inhibitor perindopril (2 or 4 mg), or matching placebo, was added if necessary to achieve the target blood pressure of 150/80 mm Hg. The primary end point was fatal or nonfatal stroke.Results: The active-treatment group (1933 patients) and the placebo group (1912 patients) were well matched (mean age, 83.6 years; mean blood pressure while sitting, 173.0/90.8 mm Hg); 11.8% had a history of cardiovascular disease. Median follow-up was 1.8 years. At 2 years, the mean blood pressure while sitting was 15.0/6.1 mm Hg lower in the active-treatment group than in the placebo group. In an intention-to-treat analysis, active treatment was associated with a 30% reduction in the rate of fatal or nonfatal stroke (95% confidence interval [CI], -1 to 51; P=0.06), a 39% reduction in the rate of death from stroke (95% CI, 1 to 62; P=0.05), a 21% reduction in the rate of death from any cause (95% CI, 4 to 35; P=0.02), a 23% reduction in the rate of death from cardiovascular causes (95% CI, -1 to 40; P=0.06), and a 64% reduction in the rate of heart failure (95% CI, 42 to 78; P