Mahmud Azra, Feely John
Department of Pharmacology and Therapeutics, Trinity College Dublin, and Trinity Centre for Health Sciences and Hypertension Clinic, St. James's Hospital, Dublin, Ireland.
Am J Hypertens. 2007 Aug;20(8):923-7. doi: 10.1016/j.amjhyper.2007.03.011.
The AB/CD British Hypertension Society guidelines predict that the blood-pressure response to antihypertensive agents A (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers) or B (beta blockers) drugs is better in those aged<55 years, whereas that to agents C (calcium channel blockers) or D (diuretics) agents is better in those aged>or=55 years.
We conducted a cohort study of 175 consecutive, untreated, hypertensive whites (55% men), aged 19 to 80 years and prospectively randomized to either A/B or C/D antihypertensive agents, and in whom there was no compelling reason to choose a particular drug. Blood pressure (BP) was measured using a semiautomated device (Omron 705CM, Tokyo, Japan) at baseline and 4 weeks after therapy in a single, blind fashion.
There was no difference in baseline BP (mean+/-SEM, A/B, 163+/-2/97+/-1 v C/D, 163+/-2/95+/-1 mm Hg). Whereas the A/B drugs were more effective in younger than older patients, expressed as percentage of reduction (13%+/-1%/12%+/-1% v 8.5%+/-1%/7%+/-1%, P<.01), as absolute reduction, or by classification of mean+/-SEM blood pressure into stages of hypertension, the C/D drugs were no more effective than A/B drugs in those aged>55 years.
The arbitrary choice of age 55 years to predict the response to antihypertensive agents in a white population is not supported by our data. A prospective, multicenter study is required to underpin guideline recommendations in relation to using age as a determinant for choice of a particular antihypertensive drug in defined hypertensive populations.
英国高血压学会的AB/CD指南预测，年龄＜55岁的患者对抗高血压药物A（血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂）或B（β受体阻滞剂）的血压反应更佳，而年龄≥55岁的患者对药物C（钙通道阻滞剂）或D（利尿剂）的反应更佳。
我们对175例未经治疗的连续性高血压白人（55%为男性）进行了一项队列研究，这些患者年龄在19至80岁之间，前瞻性地随机分为A/B或C/D抗高血压药物治疗组，且没有选择特定药物的紧迫理由。在基线期和治疗4周后，采用半自动设备（日本东京欧姆龙705CM）以单盲方式测量血压（BP）。
基线血压无差异（均值±标准误，A/B组为163±2/97±1，C/D组为163±2/95±1 mmHg）。A/B类药物在年轻患者中比老年患者更有效，以降低百分比表示（13%±1%/12%±1%对8.5%±1%/7%±1%，P＜0.01），以绝对降低值表示，或以均值±标准误血压分类为高血压阶段表示，C/D类药物在年龄＞55岁的患者中并不比A/B类药物更有效。
我们的数据不支持以55岁作为预测白人人群对抗高血压药物反应的随意选择。需要进行一项前瞻性、多中心研究，以支持在特定高血压人群中使用年龄作为选择特定抗高血压药物的决定因素的指南建议。
