Román O, Basso B, Cuevas G, Martínez D, Cumsille F
Departamento de Medicina, Facultad de Medicina (División Centro), Universidad de Chile, Santiago.
Rev Med Chil. 1991 Jul;119(7):744-52.
In order to establish morbidity and mortality in treated patients with essential hypertension, a prospective study was started in 1974. 714 patients were followed for 15 years. Admission criteria included diastolic blood pressure over 95 mmHg during one month on placebo, absence of malignant or accelerated hypertension and no recent (6 month) cardiovascular complication. According to target organ damage, 51% of patients were in WHO stage I, 35% in stage II and 14% in stage III. There were 342 males and 372 females, with mean age 58.7 +/- 9.8 years. Mean initial blood pressure was 181/110 +/- 12/8.9 mmHg. Treatment schedules included diuretics alone (23%), beta blockers alone (32%), diuretic and betablocker (38%), combined therapy with vasodilators (9%) and other forms of therapy (5%). 75 subjects failed to comply with therapy but were maintained in the analysis (intention to treat). A significant reduction in blood pressure was observed in the group as a whole (154/93 +/- 7/9 mmHg). Sustained normalization of BP (< 90 mmHg) was obtained in 40.2% of patients, reductions to between 91 and 100 mmHg in 37.2% and reductions to over 101 mmHg in 22.5% 47 patients died from cerebro vascular complications (15-year cumulative death rate of 12.3%). Total morbidity rate was 40.1% (232 events) with 61 coronary events (13.3%), 43 cerebrovascular events (8.7%), 30 cases of heart failure (12.9%) and 21 cases of renal failure (4.3%). These figures are in agreement with internationally reported ones with the exception of coronary morbidity which appears lower in this study.
为了确定接受治疗的原发性高血压患者的发病率和死亡率，1974年开展了一项前瞻性研究。714名患者接受了15年的随访。纳入标准包括在服用安慰剂的一个月内舒张压超过95 mmHg，无恶性或急进性高血压，且近期（6个月内）无心血管并发症。根据靶器官损害情况，51%的患者处于WHO I期，35%处于II期，14%处于III期。男性342例，女性372例，平均年龄58.7±9.8岁。初始平均血压为181/110±12/8.9 mmHg。治疗方案包括单独使用利尿剂（23%）、单独使用β受体阻滞剂（32%）、利尿剂和β受体阻滞剂联合使用（38%）、与血管扩张剂联合治疗（9%）以及其他治疗形式（5%）。75名受试者未遵守治疗方案，但仍纳入分析（意向性治疗）。整个组的血压显著降低（154/93±7/9 mmHg）。40.2%的患者血压持续正常化（<90 mmHg），37.2%的患者血压降至91至100 mmHg之间，22.5%的患者血压降至超过101 mmHg。47例患者死于脑血管并发症（15年累积死亡率为12.3%）。总发病率为40.1%（232例事件），其中61例为冠心病事件（13.3%），43例为脑血管事件（8.7%），30例为心力衰竭（12.9%），21例为肾衰竭（4.3%）。除了本研究中冠心病发病率似乎较低外，这些数据与国际报告的数据一致。
