Román Oscar, Cuevas Gerardo, Badilla Marta, Valenzuela Angélica, Cumsille Francisco, Valverde Luis, Rodríguez Norma
Departamento de Medicina, Campus Centro, Hospital San Borja-Arriarán y Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago de Chile.
Rev Med Chil. 2002 Apr;130(4):379-86.
Treatment has a definitive impact on mortality in hypertension. The magnitude of blood pressure reduction, the type of drug used and the associated risk factors may modulate the effect of treatment on mortality.
To report the effects of treatment of essential hypertension, in a cohort followed for up to 26 years.
A cohort of 1,172 essential hypertensive patients followed up to 26 years. Patients were treated with different antihypertensive drugs, alone or in combination (diuretics, beta blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) according to international rules and consensus. Subjects were followed until death or loss from follow-up. Blood pressure reduction was aimed to obtain figures near 140/90 mm Hg. Causes of death and complications were obtained from hospital records, phone and death certificates. Survival was studied using life tables (Kaplan Meier method and intention to treat analysis) and Cox proportional hazard analysis.
Initial blood pressure dropped significantly from 181/109 to 154/92 mm Hg, p < 0.001. Mean follow-up time was 10.6 +/- 6.1 years. There were 143 cardiovascular deaths, 142 acute myocardial infarctions, 101 strokes, 83 subjects had cardiac failure and 49 had renal failure. The observed rates were 0.92% per year for cardiovascular mortality, 1.36% per year for coronary heart disease, 0.94% per year for stroke.
Our mortality rate is lower than that found in classical randomized studies but similar or slightly higher than the more recent ones. Morbidity rates were also very similar. Except for mortality rate, frequency of complications did not change in comparison to our previous report after 15 year of follow up. Aging did not seem to negatively influence mortality rates in adequately treated hypertensive patients.
治疗对高血压患者的死亡率有决定性影响。血压降低的幅度、所用药物的类型以及相关危险因素可能会调节治疗对死亡率的影响。
报告对一组长达26年随访的原发性高血压患者进行治疗的效果。
一组1172例原发性高血压患者随访长达26年。根据国际规则和共识，患者单独或联合使用不同的抗高血压药物（利尿剂、β受体阻滞剂、钙通道阻滞剂和血管紧张素转换酶抑制剂）进行治疗。对受试者进行随访直至死亡或失访。血压降低目标是使数值接近140/90 mmHg。死亡原因和并发症信息来自医院记录、电话及死亡证明。使用生命表（Kaplan-Meier法和意向性分析）及Cox比例风险分析研究生存率。
初始血压从181/109 mmHg显著降至154/92 mmHg，p<0.001。平均随访时间为10.6±6.1年。有143例心血管死亡、142例急性心肌梗死、101例中风、83例患者发生心力衰竭、49例患者发生肾衰竭。心血管死亡率为每年0.92%，冠心病为每年1.36%，中风为每年0.94%。
我们的死亡率低于经典随机研究中的死亡率，但与近期研究相似或略高。发病率也非常相似。除死亡率外，随访15年后并发症发生率与我们之前的报告相比没有变化。在接受充分治疗的高血压患者中，衰老似乎并未对死亡率产生负面影响。
