Cardiovascular Health Research Unit, University of Washington, Seattle, WA 98101, USA.
BMJ. 2010 Jan 25;340:c103. doi: 10.1136/bmj.c103.
To examine the association of myocardial infarction and stroke incidence with several commonly used two drug antihypertensive treatment regimens. Design Population based case-control study. Setting Group Health Cooperative, Seattle, WA, USA.
Cases (n=353) were aged 30-79 years, had pharmacologically treated hypertension, and were diagnosed with a first fatal or non-fatal myocardial infarction or stroke between 1989 and 2005. Controls (n=952) were a random sample of Group Health members who had pharmacologically treated hypertension. We excluded individuals with heart failure, evidence of coronary heart disease, diabetes, or chronic kidney disease. Exposures One of three common two drug combinations: diuretics plus beta blockers; diuretics plus calcium channel blockers; and diuretics plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers.
Myocardial infarction or stroke.
Compared with users of diuretics plus beta blockers, users of diuretics plus calcium channel blockers had an increased risk of myocardial infarction (adjusted odds ratio (OR) 1.98, 95% confidence interval 1.37 to 2.87) but not of stroke (OR 1.02, 95% CI 0.63 to 1.64). The risks of myocardial infarction and stroke in users of diuretics plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers were slightly but not significantly lower than in users of diuretics plus beta blockers (myocardial infarction: OR 0.76, 95% CI 0.52 to 1.11; stroke: OR 0.71, 95% CI 0.46 to 1.10).
In patients with hypertension, diuretics plus calcium channel blockers were associated with a higher risk of myocardial infarction than other common two drug treatment regimens. A large trial of second line antihypertensive treatments in patients already on low dose diuretics is required to provide a solid basis for treatment recommendations.
研究几种常用的两种药物降压治疗方案与心肌梗死和中风发生率的关系。
基于人群的病例对照研究。
美国华盛顿州西雅图的 Group Health Cooperative。
病例（n=353）年龄在 30-79 岁之间，接受药物治疗的高血压患者，并在 1989 年至 2005 年间被诊断出首次致命或非致命性心肌梗死或中风。对照组（n=952）为 Group Health 成员的随机样本，他们患有药物治疗的高血压。我们排除了心力衰竭、冠心病、糖尿病或慢性肾病的患者。
三种常见的两种药物组合之一：利尿剂加β受体阻滞剂；利尿剂加钙通道阻滞剂；利尿剂加血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。
心肌梗死或中风。
与使用利尿剂加β受体阻滞剂的患者相比，使用利尿剂加钙通道阻滞剂的患者心肌梗死的风险增加（调整后的优势比（OR）1.98，95%置信区间 1.37 至 2.87），但中风的风险没有增加（OR 1.02，95%置信区间 0.63 至 1.64）。使用利尿剂加血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的患者发生心肌梗死和中风的风险略低于使用利尿剂加β受体阻滞剂的患者（心肌梗死：OR 0.76，95%置信区间 0.52 至 1.11；中风：OR 0.71，95%置信区间 0.46 至 1.10）。
在高血压患者中，与其他常用的两种药物治疗方案相比，利尿剂加钙通道阻滞剂与心肌梗死风险增加相关。需要对已经使用低剂量利尿剂的患者进行二线降压治疗的大型试验，为治疗建议提供坚实的基础。
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