Wassertheil-Smoller S, Blaufox M D, Oberman A S, Langford H G, Davis B R, Wylie-Rosett J
Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461.
Arch Intern Med. 1992 Jan;152(1):131-6.
This report examines the effect of weight loss, alone and in combination with drugs, on diastolic blood pressure change in the Trial of Antihypertensive Interventions and Management (TAIM), which is a randomized, multicenter, placebo-controlled clinical trial of drug and diet combinations in the treatment of mild hypertension among 787 patients. Diastolic blood pressure drop (11.6 mm Hg) at 6 months among those patients who were randomized to weight reduction and placebo drug treatment was greater among those who lost 4.5 kg or more, than the 7-mm Hg drop for those who lost less than 2.25 kg or for the placebo-treated control group, and it was statistically equivalent to the reduction achieved by 25 mg of chlorthalidone or 50 mg of atenolol (11.1- and 12.4-mm Hg drop, respectively). Weight loss potentiated effects of drugs, with reductions of 18.4 mm Hg, for those patients who were taking atenolol and had a 4.5-kg or more weight loss, and of 15.4 mm Hg, for those patients who were taking chlorthalidone and had at least a 2.25-kg weight loss. We concluded that effective weight loss (greater than or equal to 4.5 kg) lowers blood pressure similarly to low-dose drug therapy and potentiates drug effects, with the apparent 4.5-kg threshold being lowered to 2.25 kg for those patients who receive chlorthalidone.
本报告在高血压干预和管理试验（TAIM）中，研究了单纯减肥以及减肥与药物联合使用对舒张压变化的影响。TAIM是一项随机、多中心、安慰剂对照的临床试验，研究药物与饮食组合对787例轻度高血压患者的治疗效果。随机接受减重和安慰剂药物治疗的患者中，体重减轻4.5千克或更多的患者在6个月时的舒张压下降幅度（11.6毫米汞柱），大于体重减轻不足2.25千克的患者或接受安慰剂治疗的对照组的7毫米汞柱下降幅度，且在统计学上与25毫克氯噻酮或50毫克阿替洛尔所实现的血压降低幅度相当（分别为11.1毫米汞柱和12.4毫米汞柱下降）。减肥增强了药物的效果，服用阿替洛尔且体重减轻4.5千克或更多的患者血压降低18.4毫米汞柱，服用氯噻酮且体重至少减轻2.25千克的患者血压降低15.4毫米汞柱。我们得出结论，有效的体重减轻（大于或等于4.5千克）降低血压的效果与低剂量药物治疗相似，并且增强了药物效果，对于接受氯噻酮治疗的患者，明显的4.5千克阈值降至2.25千克。
