Langford H G, Davis B R, Blaufox D, Oberman A, Wassertheil-Smoller S, Hawkins M, Zimbaldi N
Department of Medicine, University of Mississippi Medical Center, Jackson.
Hypertension. 1991 Feb;17(2):210-7. doi: 10.1161/01.hyp.17.2.210.
The Trial of Antihypertensive Interventions and Management is a multicenter randomized trial designed to examine the diastolic blood pressure response of various combinations of pharmacological and dietary interventions in the treatment of mild hypertension (diastolic blood pressure 90-100 mm Hg). Eight hundred and seventy-eight participants at 110-160% of ideal weight were randomly allocated to nine drug/diet treatment groups receiving either a placebo, chlorthalidone (25 mg), or atenolol (50 mg), combined with a usual, a weight loss, or a low sodium/high potassium diet. The primary outcome was diastolic blood pressure change from baseline to 6 months. Seven hundred and eighty-seven participants had follow-up data. The mean baseline diastolic blood pressure was 93.8 mm Hg; 55.9% of the participants were male, and the weight loss diet group lost an average of 4.7 kg. Multiple comparisons were accounted for in the analysis. A significantly greater lowering of diastolic blood pressure (12.4 mm Hg) was achieved in the atenolol group compared with either the low sodium/high potassium diet group (7.9 mm Hg, p = 0.001) or weight loss group (8.8 mm Hg, p = 0.006). Adding weight loss to chlorthalidone significantly enhanced blood pressure lowering (15.1 mm Hg) when compared with the diuretic alone (10.8 mm Hg, p = 0.002), but adding a low sodium/high potassium diet (12.2 mm Hg, p = 0.029) did not. In the short-term treatment of mild hypertension where diastolic blood pressure is the sole consideration, drugs outperform diet, and weight loss is beneficial, especially with diuretics.
降压干预与管理试验是一项多中心随机试验，旨在研究药物和饮食干预的各种组合在治疗轻度高血压（舒张压90 - 100毫米汞柱）时对舒张压的反应。878名体重为理想体重110% - 160%的参与者被随机分配到9个药物/饮食治疗组，这些组分别接受安慰剂、氯噻酮（25毫克）或阿替洛尔（50毫克），并结合常规饮食、减肥饮食或低钠/高钾饮食。主要结局是从基线到6个月的舒张压变化。787名参与者有随访数据。平均基线舒张压为93.8毫米汞柱；55.9%的参与者为男性，减肥饮食组平均减重4.7千克。分析中考虑了多重比较。与低钠/高钾饮食组（7.9毫米汞柱，p = 0.001）或减肥组（8.8毫米汞柱，p = 0.006）相比，阿替洛尔组的舒张压显著降低更多（12.4毫米汞柱）。与单独使用利尿剂（10.8毫米汞柱，p = 0.002）相比，氯噻酮联合减肥可显著增强血压降低效果（15.1毫米汞柱），但联合低钠/高钾饮食（12.2毫米汞柱，p = 0.029）则不然。在仅以舒张压为考量的轻度高血压短期治疗中，药物优于饮食，减肥有益，尤其是与利尿剂联合使用时。
