Wassertheil-Smoller S, Blaufox M D, Oberman A, Davis B R, Swencionis C, Knerr M O, Hawkins C M, Langford H G
Albert Einstein College of Medicine, Bronx, NY 10461.
Ann Intern Med. 1991 Apr 15;114(8):613-20. doi: 10.7326/0003-4819-114-8-613.
To evaluate treatment of mild hypertension using combinations of diet and low-dose pharmacologic therapies.
Multicenter, randomized, placebo-controlled clinical trial.
Three university-based tertiary care centers.
Patients (697) 21 to 65 years of age with diastolic blood pressure between 90 and 100 mm Hg as well as weight between 110% and 160% of ideal weight.
Patients were stratified by clinical center and race and were randomly assigned to one of three diets (usual, low-sodium and high-potassium, weight loss) and one of three agents (placebo, chlorthalidone, and atenolol).
Changes in measures of sexual problems, distress, and well-being after 6 months of therapy were analyzed.
Low-dose chlorthalidone and atenolol produced few side effects, except in men. Erection-related problems worsened in 28% (95% CI, 15% to 41%) of men receiving chlorthalidone and usual diet compared with 3% (CI, 0% to 9%) of those receiving placebo and usual diet (P = 0.009) and 11% (CI, 2% to 20%) of those receiving atenolol and usual diet (P greater than 0.05). The weight loss diet ameliorated this effect. The low-sodium diet with placebo was associated with greater fatigue (34%; CI, 23% to 45%) than was either usual diet (18%; CI, 10% to 27%; P = 0.04) or weight reduction (15%; CI, 7% to 23%; P = 0.009). The low-sodium diet with chlorthalidone increased problems with sleep (32%; CI, 22% to 42%) compared with chlorthalidone and usual diet (16%; CI, 8% to 24%; P = 0.04). The weight loss diet benefited quality of life most, reducing total physical complaints (P less than 0.001) and increasing satisfaction with health (P less than 0.001). Total physical complaints decreased in 57% to 76% of patients depending on drug and diet group, and were markedly decreased by weight loss.
In general, low-dose antihypertensive drug therapy (with chlorthalidone or atenolol) improves rather than impairs the quality of life; however, chlorthalidone with usual diet increases sexual problems in men.
评估饮食与低剂量药物联合疗法对轻度高血压的治疗效果。
多中心、随机、安慰剂对照临床试验。
三个大学附属三级医疗中心。
697名年龄在21至65岁之间的患者，舒张压在90至100毫米汞柱之间，体重为理想体重的110%至160%。
患者按临床中心和种族分层，随机分配至三种饮食方案（常规饮食、低钠高钾饮食、减肥饮食）之一及三种药物（安慰剂、氯噻酮、阿替洛尔）之一。
分析治疗6个月后性问题、困扰及幸福感指标的变化。
低剂量氯噻酮和阿替洛尔除对男性外副作用较少。与接受安慰剂和常规饮食的男性（3%，95%可信区间为0%至9%）及接受阿替洛尔和常规饮食的男性（11%，可信区间为2%至20%）相比，接受氯噻酮和常规饮食的男性中有28%（95%可信区间为15%至41%）出现勃起相关问题恶化（P = 0.009）。减肥饮食改善了这种影响。与常规饮食（18%，可信区间为10%至27%；P = 0.04）或减肥饮食（15%，可信区间为7%至23%；P = 0.009）相比，服用安慰剂的低钠饮食导致更多疲劳感（34%，可信区间为23%至45%）。与氯噻酮和常规饮食（16%，可信区间为8%至24%；P = 0.04）相比，氯噻酮与低钠饮食联合使用增加了睡眠问题（32%，可信区间为22%至42%）。减肥饮食对生活质量益处最大，减少了总体身体不适（P < 0.001）并提高了对健康的满意度（P < 0.001）。根据药物和饮食组不同，57%至76%的患者总体身体不适有所减轻，且减肥使其明显减轻。
总体而言，低剂量抗高血压药物治疗（使用氯噻酮或阿替洛尔）改善而非损害生活质量；然而，氯噻酮与常规饮食会增加男性的性问题。
