Lee Chan J, Hwang Jinseub, Oh Jaewon, Lee Sang-Hak, Kang Seok-Min, Choi Donghoon, Kim Hyeon-Chang, Park Sungha
aDivision of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul bDepartment of Computer Science and Statistics, Daegu University, Gyeongsan, Gyeongbuk cDepartment of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Hypertens. 2017 May;35 Suppl 1:S41-S49. doi: 10.1097/HJH.0000000000001331.
Although the benefit of hypertension treatment is well established in high-risk patients, there is a paucity of evidence regarding the benefit of treatment in patients with uncomplicated hypertension.
Hypertensive adult patients were selected from the Korea National Health Insurance Sample Cohort in 2002 and were followed until 2013. Patients with a diagnosis of heart failure, coronary artery disease, stroke, malignancy, diabetes, or chronic kidney disease were excluded. Ultimately, 40 496 patients were divided into three groups: never-treated (N = 6756), treated-from-baseline (N = 28 443), and treated-during-follow-up (N = 5297). Five first-line antihypertensive agents were categorized into four classes: renin-angiotensin system blocker (RASB), beta-blocker, calcium channel blocker (CCB), and diuretics. All-cause mortality, cardiovascular mortality, and hazard ratio were determined.
All-cause and cardiovascular mortality rates were significantly lower in both treatment groups than in the never-treated group (all log-rank P < 0.001). Treatment from baseline (hazard ratio = 0.49 for all-cause mortality and hazard ratio = 0.62 for cardiovascular mortality) and treatment started during follow-up (hazard ratio = 0.41 for all-cause mortality and hazard ratio = 0.44 for cardiovascular mortality) were independently associated with lower mortality on multivariable Cox analyses. Although RASB, beta-blocker, and CCB significantly reduced all-cause mortality, multivariable Cox analyses showed that RASB and CCB were closely associated with lower all-cause mortality. In terms of cardiovascular mortality, only CCB was associated with lower cardiovascular mortality on multivariable Cox analyses.
Treatment of hypertension significantly reduces mortality in patients with uncomplicated hypertension.
尽管高血压治疗对高危患者的益处已得到充分证实，但关于单纯性高血压患者治疗益处的证据却很少。
2002年从韩国国民健康保险样本队列中选取成年高血压患者，并随访至2013年。排除诊断为心力衰竭、冠状动脉疾病、中风、恶性肿瘤、糖尿病或慢性肾脏病的患者。最终，40496例患者被分为三组：从未治疗组（N = 6756）、基线时开始治疗组（N = 28443）和随访期间开始治疗组（N = 5297）。五种一线抗高血压药物分为四类：肾素-血管紧张素系统阻滞剂（RASB）、β受体阻滞剂、钙通道阻滞剂（CCB）和利尿剂。确定全因死亡率、心血管死亡率和风险比。
两个治疗组的全因死亡率和心血管死亡率均显著低于未治疗组（所有对数秩检验P < 0.001）。在多变量Cox分析中，基线时开始治疗（全因死亡率风险比 = 0.49，心血管死亡率风险比 = 0.62）和随访期间开始治疗（全因死亡率风险比 = 0.41，心血管死亡率风险比 = 0.44）与较低的死亡率独立相关。尽管RASB、β受体阻滞剂和CCB显著降低了全因死亡率，但多变量Cox分析表明，RASB和CCB与较低的全因死亡率密切相关。就心血管死亡率而言，在多变量Cox分析中，只有CCB与较低的心血管死亡率相关。
高血压治疗可显著降低单纯性高血压患者的死亡率。
