MacMahon S
Department of Medicine, University of Auckland, New Zealand.
J Cardiovasc Pharmacol. 1991;18 Suppl 2:S59-63.
Previous trials have shown that a 5-6 mm Hg reduction in diastolic blood pressure produced by antihypertensive treatment (mainly diuretics) reduces the risk of coronary artery disease (CAD) by 14% SD5 (2p less than 0.01). However, the 95% confidence limits for this estimate of treatment effect are wide and consistent, with true reductions as small as 4% or as large as 22%. For this reason, it is not possible to determine whether the treatment benefit is of a worthwhile magnitude. Because CAD remains the leading cause of death in hypertensive patients (and normotensive patients) in most Western populations, further studies are required to determine more precisely the effect of blood pressure reduction on the incidence of CAD. This could be achieved by further large-scale studies comparing antihypertensive treatment with no treatment. It could also be achieved by comparing the effects of more and less intensive antihypertensive treatment regimens. Additional relevant information might also be generated by studies comparing the effects on CAD of new classes of antihypertensive drugs (such as angiotensin-converting enzyme inhibitors and calcium antagonists) with those of older classes (in particular diuretics). In all such studies, the detection of plausible treatment effects or of plausible treatment differences requires the recruitment of large study populations with follow-up continued for several years. This is only feasible if study methods are kept simple to insure the widest possible collaboration.
先前的试验表明，降压治疗（主要是利尿剂）使舒张压降低5 - 6毫米汞柱可使冠状动脉疾病（CAD）风险降低14%（标准差5，P值小于0.01）。然而，该治疗效果估计值的95%置信区间很宽且具有一致性，真实降低幅度小至4%或大至22%。因此，无法确定治疗益处是否具有值得追求的程度。由于在大多数西方人群中，CAD仍是高血压患者（以及血压正常者）的主要死因，所以需要进一步研究以更精确地确定血压降低对CAD发病率的影响。这可以通过进一步的大规模研究来实现，即比较降压治疗与不治疗的效果。也可以通过比较强化程度不同的降压治疗方案的效果来实现。比较新型降压药物（如血管紧张素转换酶抑制剂和钙拮抗剂）与旧型药物（特别是利尿剂）对CAD的影响的研究，可能也会产生其他相关信息。在所有此类研究中，要检测出合理的治疗效果或合理的治疗差异，需要招募大量研究人群并持续随访数年。只有在研究方法保持简单以确保尽可能广泛的合作时，这才可行。
