Oberman A, Wassertheil-Smoller S, Langford H G, Blaufox M D, Davis B R, Blaszkowski T, Zimbaldi N, Hawkins C M
University of Alabama, Birmingham.
Ann Intern Med. 1990 Jan 15;112(2):89-95. doi: 10.7326/0003-4819-112-2-89.
To evaluate the 6-month change in cardiovascular (coronary heart disease) risk as a function of diet and drug therapy for mild hypertension.
Collaborative randomized, controlled clinical trial to assess the efficacy of alternative regimens in treating mild hypertension.
Three university-based tertiary care centers-the Trial of Antihypertensive Interventions and Management (TAIM).
Six hundred and ninety-two men and women ages 21 to 65 years with diastolic blood pressure between 90 and 100 mm Hg and weight between 110% and 160% of ideal weight.
Patients stratified by clinical center and race were randomized into diet (usual, low sodium-high potassium, weight loss) and drug (placebo, chlorthalidone, and atenolol) groups resulting in nine diet plus drug combinations. The cardiovascular risk at 6-month follow-up was estimated relative to baseline in 692 participants using the Framingham Study model. Due to the blood pressure reduction, cardiovascular risk declined from baseline for all treatment groups (except the usual diet plus chlorthalidone group because of increased cholesterol levels). The relative cardiovascular risk at 6 months compared to baseline ranged from 0.83 in the weight loss plus atenolol subgroup to 1.03 in the usual diet plus chlorthalidone subgroup. The active drug plus weight loss groups showed the lowest relative cardiovascular risk at 6 months.
Mild hypertension was generally reduced to desirable levels within 6 months by monotherapy. Evaluating blood pressure changes together with the risk factors indicated a differential effect on overall cardiovascular risk depending on the diet and drug used. Dietary therapy, particularly weight reduction, was important adjunctive treatment in reducing overall cardiovascular risk.
评估饮食和药物治疗对轻度高血压患者心血管（冠心病）风险的6个月变化情况。
协作随机对照临床试验，以评估替代治疗方案治疗轻度高血压的疗效。
三个大学附属三级护理中心——降压干预与管理试验（TAIM）。
692名年龄在21至65岁之间的男性和女性，舒张压在90至100毫米汞柱之间，体重在理想体重的110%至160%之间。
按临床中心和种族分层的患者被随机分为饮食组（常规饮食、低钠高钾饮食、减重饮食）和药物组（安慰剂、氯噻酮和阿替洛尔），产生九种饮食加药物的组合。使用弗明汉研究模型，对692名参与者随访6个月时的心血管风险相对于基线进行了估计。由于血压降低，所有治疗组的心血管风险均较基线下降（常规饮食加氯噻酮组除外，因其胆固醇水平升高）。6个月时与基线相比的相对心血管风险范围为，减重加阿替洛尔亚组为0.83，常规饮食加氯噻酮亚组为1.03。活性药物加减重组在6个月时显示出最低的相对心血管风险。
通过单一疗法，轻度高血压一般在6个月内可降至理想水平。将血压变化与风险因素一起评估表明，根据所使用的饮食和药物，对总体心血管风险有不同影响。饮食疗法，尤其是减重，是降低总体心血管风险的重要辅助治疗方法。
