Ekbom T, Dahlöf B, Hansson L, Lindholm L H, Scherstén B, Wester P O
Health Sciences Centre, University of Lund, Dalby, Sweden.
J Hypertens. 1992 Dec;10(12):1525-30. doi: 10.1097/00004872-199210120-00013.
To compare the blood pressure-lowering efficacy, the frequency of side effects and changes in laboratory values of three beta-blockers and a potassium-sparing diuretic combination in elderly hypertensive patients.
The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomized, double-blind, multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70-84 years.
The study group consisted of 1627 elderly hypertensive patients (mean +/- SD age 75.7 +/- 3.7 years; 37% males, 63% females). Supine and standing blood pressure, heart rate and side effects were recorded at each visit. Blood was drawn for routine analysis. The mean length of follow-up was 25 months (range 6-65). No patient was lost to follow-up.
After 2-months' single-drug therapy, all four active drugs were found to be equally effective in reducing diastolic blood pressure (DBP). However, there were differences in their efficacy in reducing systolic blood pressure (SBP); the diuretic was significantly more effective than the beta-receptor blockers. The results of a series of multiple linear regression analyses showed that the observed differences in effect on SBP could not be explained by the different effects of the drugs on heart rate. More than two-thirds of the patients were given supplementary treatment, most of them already by the 2-month visit, after which there was no significant difference in blood pressure among the treatment regimens. The changes in laboratory values and in the prevalence of symptoms were minor for all four regimens.
Metoprolol (controlled release), atenolol, pindolol and the combination hydrochlorothiazide + amiloride were equally effective as single drugs in reducing DBP. There were differences in their efficacy in reducing SBP, the diuretic being more effective than the beta-blockers. After addition of supplementary treatment (beta-blocker to diuretic, or vice versa) there were no significant differences in blood pressure reduction among the groups. The changes in laboratory values and in the prevalence of symptoms were minor for all active treatment regimens. Thus, the satisfactory effect on cardiovascular morbidity and mortality was not impaired by low tolerability of the drugs.
比较三种β受体阻滞剂与一种保钾利尿剂联合用药在老年高血压患者中的降压疗效、副作用发生频率及实验室检查值的变化。
瑞典老年高血压患者试验（STOP - 高血压试验）是一项前瞻性、随机、双盲、多中心试验，比较70 - 84岁患者中活性抗高血压治疗与安慰剂治疗的效果。
研究组由1627例老年高血压患者组成（平均年龄±标准差为75.7±3.7岁；男性占37%，女性占63%）。每次就诊时记录仰卧位和站立位血压、心率及副作用。采集血样进行常规分析。平均随访时间为25个月（范围6 - 65个月）。无患者失访。
经过2个月的单药治疗，发现所有四种活性药物在降低舒张压（DBP）方面同样有效。然而，它们在降低收缩压（SBP）方面的疗效存在差异；利尿剂在降低收缩压方面明显比β受体阻滞剂更有效。一系列多元线性回归分析结果表明，观察到的对收缩压影响的差异不能用药物对心率的不同影响来解释。超过三分之二的患者接受了补充治疗，大多数患者在2个月就诊时就已接受，此后各治疗方案之间血压无显著差异。所有四种治疗方案的实验室检查值变化和症状发生率变化都较小。
美托洛尔（缓释）、阿替洛尔、吲哚洛尔以及氢氯噻嗪 + 阿米洛利联合用药作为单药在降低舒张压方面同样有效。它们在降低收缩压方面的疗效存在差异，利尿剂比β受体阻滞剂更有效。添加补充治疗（β受体阻滞剂加利尿剂，或反之）后，各组间血压降低无显著差异。所有活性治疗方案的实验室检查值变化和症状发生率变化都较小。因此，药物耐受性低并未损害对心血管发病率和死亡率的满意疗效。
