The George Institute for Global Health, University of Sydney and the Royal Prince Alfred Hospital, Australia.
Stroke. 2011 Aug;42(8):2339-41. doi: 10.1161/STROKEAHA.110.606764. Epub 2011 Jun 23.
Despite clear evidence that blood pressure (BP) lowering is effective for prevention of cardiovascular events among patients with isolated systolic hypertension and systolic-diastolic hypertension, there is ongoing uncertainty about its effects in those with isolated diastolic hypertension. The objective of the present analysis is to determine whether BP lowering provides benefits to patients with isolated diastolic hypertension.
Patients with cerebrovascular disease and hypertension at baseline (n=4283) were randomly assigned to either active treatment (perindopril in all participants plus indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). The primary outcome was total major vascular events.
There were 1923 patients with isolated systolic hypertension (systolic BP ≥ 140 mm Hg and diastolic BP < 90 mm Hg), 315 with isolated diastolic hypertension (systolic BP <140 mm Hg and diastolic BP ≥ 90 mm Hg), and 2045 with systolic-diastolic hypertension (systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg) at baseline. Active treatment reduced the relative risk of major vascular events by 27% (95% CI, 10% to 41%) among patients with isolated systolic hypertension, by 28% (-29% to 60%) among those with isolated diastolic hypertension, and by 32% (17% to 45%) among those with systolic-diastolic hypertension. There was no evidence of differences in the magnitude of the effects of treatment among different types of hypertension (P homogeneity=0.89).
BP lowering is likely to provide a similar level of protection against major vascular events for patients with isolated diastolic hypertension as for those with isolated systolic hypertension and systolic-diastolic hypertension. Clinical Trial Registration Information- This trial was not registered because patients were enrolled before July 1, 2005.
尽管有明确的证据表明降压治疗对单纯收缩期高血压和收缩期-舒张期高血压患者预防心血管事件有效，但对于单纯舒张期高血压患者的疗效仍存在不确定性。本分析旨在确定降压治疗是否对单纯舒张期高血压患者有益。
基线时有脑血管疾病和高血压的患者（n=4283）被随机分配至活性治疗组（所有参与者给予培哚普利，对于既无利尿剂适应证也无禁忌证的患者给予吲达帕胺）或匹配的安慰剂组。主要终点是总主要血管事件。
基线时有 1923 例单纯收缩期高血压（收缩压≥140mmHg 且舒张压<90mmHg）、315 例单纯舒张期高血压（收缩压<140mmHg 且舒张压≥90mmHg）和 2045 例收缩期-舒张期高血压（收缩压≥140mmHg 且舒张压≥90mmHg）患者。活性治疗使单纯收缩期高血压患者的主要血管事件相对风险降低了 27%（95%CI，10%至 41%），使单纯舒张期高血压患者的相对风险降低了 28%（-29%至 60%），使收缩期-舒张期高血压患者的相对风险降低了 32%（17%至 45%）。不同类型高血压患者治疗效果的大小无差异（P 同质性=0.89）。
降压治疗可能为单纯舒张期高血压患者提供与单纯收缩期高血压和收缩期-舒张期高血压患者相似水平的主要血管事件保护。
临床试验注册信息- 本试验未注册，因为患者是在 2005 年 7 月 1 日之前招募的。
