Gudmundsson L S, Johannsson M, Thorgeirsson G, Sigfusson N, Sigvaldason H, Witteman J C M
Department of Pharmacology and Toxicology, University of Iceland, Reykjavík, Iceland.
J Hum Hypertens. 2004 Sep;18(9):615-22. doi: 10.1038/sj.jhh.1001725.
The aim was to examine the risk profiles and prognosis of treated and untreated hypertensive subjects and examine to what degree confounding by indication was present in a population-based cohort study with up to 30-year follow-up. The study population consisted of 9328 men and 10 062 women, aged 33-87 years at the time of attendance from 1967 to 1996. The main outcome measures were myocardial infarction (MI), cardiovascular disease (CVD) mortality and all-cause mortality. Comparing the risk profiles between treated and untreated subjects entering the study showed significantly higher values for some risk factors for treated subjects. During the first 10 years, hypertensive men without treatment, compared with those treated, had a significantly lower risk of suffering MI, CVD and all-cause mortality, hazard ratio (HR) 0.72 (95% CI; 0.57, 0.90), 0.75 (95% CI; 0.59, 0.95) and 0.81 (95% CI; 0.61, 0.98), respectively. No significant differences in outcome were seen during the following 20 years. In identically defined groups of women, no significant differences in mortality were seen between groups. Subgroup analysis, at two stages of the study 5 years apart, revealed that some cardiovascular risk factors had a higher prevalence in hypertensive men who were treated at the later stage, compared with those who remained untreated (P=0.004). In conclusion, hypertensive treated men had a worse prognosis during the first 10 years of follow-up than untreated ones, which is most likely due to worse baseline risk profile. Hypertensive men that were treated at a later stage had a worse risk profile than those not treated at a later stage.
目的是研究接受治疗和未接受治疗的高血压患者的风险状况及预后，并在一项长达30年随访的基于人群的队列研究中考察指征性混杂的程度。研究人群包括1967年至1996年就诊时年龄在33 - 87岁的9328名男性和10062名女性。主要结局指标为心肌梗死（MI）、心血管疾病（CVD）死亡率和全因死亡率。比较进入研究的接受治疗和未接受治疗的患者的风险状况发现，接受治疗的患者某些风险因素的值显著更高。在最初10年中，未接受治疗的高血压男性与接受治疗的男性相比，发生MI、CVD和全因死亡的风险显著更低，风险比（HR）分别为0.72（95%CI：0.57，0.90）、0.75（95%CI：0.59，0.95）和0.81（95%CI：0.61，0.98）。在随后20年中未观察到结局有显著差异。在定义相同的女性组中，各亚组之间的死亡率无显著差异。在相隔5年的研究两个阶段进行的亚组分析显示，与未接受治疗的高血压男性相比，后期接受治疗的高血压男性中一些心血管风险因素的患病率更高（P = 0.004）。总之，在随访的最初10年中，接受治疗的高血压男性的预后比未接受治疗的男性更差，这很可能是由于基线风险状况更差。后期接受治疗的高血压男性的风险状况比后期未接受治疗的男性更差。
