Cushman William C, Ford Charles E, Einhorn Paula T, Wright Jackson T, Preston Richard A, Davis Barry R, Basile Jan N, Whelton Paul K, Weiss Robert J, Bastien Arnaud, Courtney Donald L, Hamilton Bruce P, Kirchner Kent, Louis Gail T, Retta Tamrat M, Vidt Donald G
From the Veterans Affairs Medical Center, Memphis, TN, USA.
J Clin Hypertens (Greenwich). 2008 Oct;10(10):751-60. doi: 10.1111/j.1751-7176.2008.00015.x.
Blood pressure (BP) control rates and number of antihypertensive medications were compared (average follow-up, 4.9 years) by randomized groups: chlorthalidone, 12.5-25 mg/d (n=15,255), amlodipine 2.5-10 mg/d (n=9048), or lisinopril 10-40 mg/d (n=9054) in a randomized double-blind hypertension trial. Participants were hypertensives aged 55 or older with additional cardiovascular risk factor(s), recruited from 623 centers. Additional agents from other classes were added as needed to achieve BP control. BP was reduced from 145/83 mm Hg (27% control) to 134/76 mm Hg (chlorthalidone, 68% control), 135/75 mm Hg (amlodipine, 66% control), and 136/76 mm Hg (lisinopril, 61% control) by 5 years; the mean number of drugs prescribed was 1.9, 2.0, and 2.1, respectively. Only 28% (chlorthalidone), 24% (amlodipine), and 24% (lisinopril) were controlled on monotherapy. BP control was achieved in the majority of each randomized group-a greater proportion with chlorthalidone. Over time, providers and patients should expect multidrug therapy to achieve BP <140/90 mm Hg in a majority of patients.
在一项随机双盲高血压试验中，按随机分组比较了血压（BP）控制率和抗高血压药物的使用数量（平均随访4.9年）：氯噻酮，12.5 - 25毫克/天（n = 15255）、氨氯地平2.5 - 10毫克/天（n = 9048）或赖诺普利10 - 40毫克/天（n = 9054）。参与者为年龄在55岁及以上且有其他心血管危险因素的高血压患者，从623个中心招募。根据需要添加其他类别的药物以实现血压控制。5年后，血压从145/83毫米汞柱（控制率27%）降至134/76毫米汞柱（氯噻酮，控制率68%）、135/75毫米汞柱（氨氯地平，控制率66%）和136/76毫米汞柱（赖诺普利，控制率61%）；所开药物的平均数量分别为1.9、2.0和2.1种。单药治疗时，只有28%（氯噻酮）、24%（氨氯地平）和24%（赖诺普利）的患者血压得到控制。每个随机分组中的大多数患者都实现了血压控制——氯噻酮组的比例更高。随着时间推移，医疗服务提供者和患者应预期多药治疗能使大多数患者的血压降至<140/90毫米汞柱。
