Bestehorn K, Wahle Klaus
Medical Department, MSD Sharp & Dohme GmbH, Munich/Haar, Germany.
Clin Drug Investig. 2007;27(5):347-55. doi: 10.2165/00044011-200727050-00006.
While a number of conditions and risk factors that increase stroke risk have been identified, arterial hypertension is the most consistent and powerful predictor. The angiotensin II type 1 receptor antagonist (angio-tensin receptor blocker [ARB]) losartan has been shown in the LIFE (Losartan Intervention for Endpoint Reduction in Hypertension) study to decrease stroke risk in hypertensive patients to a substantially greater extent than conventional therapy. We aimed to assess the impact of the blood pressure-lowering effect of losartan therapy on stroke risk in hypertensive patients in primary care.
A total of 2977 primary-care practices throughout Germany included 22 499 consecutive unselected patients with a confirmed diagnosis of hypertension in an open-label, prospective, observational study. In addition to demographics, known risk factors for stroke were documented on standardised questionnaires. The 10-year predicted risk of first stroke was calculated according to the Framingham Stroke Risk Score at baseline and after a mean of 94 +/- 24 days of losartan (+/- hydrochlorothiazide [HCTZ]) therapy.
The mean patient age was 64.1 +/- 10.6 years, and 52.4% were males. Mean systolic/diastolic blood pressure decreased from 160 +/- 15/93 +/- 9 mm Hg at baseline by -21 +/- 14/-11 +/- 9 mm Hg. Besides hypertension, 84.9% of patients had other co-morbidities, of which the most frequent were hypercholesterolaemia (53.0%), diabetes mellitus (36.1%), coronary heart disease (31.1%) and left ventricular hypertrophy (24.2%). The average predicted 10-year stroke risk was 28.0 +/- 21.9% at baseline, and 22.1 +/- 19.5% at study end (relative risk reduction 24 +/- 16%, p<0.05). In subgroups of patients with diabetes or nephropathy, similar effects were noted. Drug-related adverse events were reported in 18 patients; all of these were non-serious.
Because of the high prevalence of co-morbidities and risk factors, the hypertensive patient population observed in this study presented with a high 10-year stroke risk. Treatment with losartan (+/- HCTZ) was well tolerated and led to a substantial decrease in blood pressure and associated stroke risk.
虽然已确定了一些增加中风风险的病症和危险因素，但动脉高血压是最稳定且最有力的预测因素。血管紧张素II 1型受体拮抗剂（血管紧张素受体阻滞剂[ARB]）氯沙坦在 LIFE（氯沙坦降低高血压终点事件研究）研究中显示，与传统治疗相比，能在更大程度上降低高血压患者的中风风险。我们旨在评估氯沙坦治疗的降压效果对基层医疗中高血压患者中风风险的影响。
在一项开放标签、前瞻性观察研究中，德国全国共有2977家基层医疗诊所纳入了22499例连续入选的确诊高血压患者。除人口统计学信息外，在标准化问卷上记录已知的中风危险因素。根据弗雷明汉姆中风风险评分在基线时以及氯沙坦（±氢氯噻嗪[HCTZ]）治疗平均94±24天后计算首次中风的10年预测风险。
患者平均年龄为64.1±10.6岁，男性占52.4%。平均收缩压/舒张压从基线时的160±15/93±9 mmHg降至 -21±14/-11±9 mmHg。除高血压外，84.9%的患者有其他合并症，其中最常见的是高胆固醇血症（53.0%）、糖尿病（36.1%）、冠心病（31.1%）和左心室肥厚（24.2%）。基线时平均预测10年中风风险为28.
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