Fletcher A E, Beevers D G, Bulpitt C J, Butler A, Coles E C, Hunt D, Munro-Faure A D, Newson R, O'Riordan P W, Petrie J C
Division of Geriatric Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
J Hum Hypertens. 1988 Jun;2(1):11-5.
The suggestion that treating blood pressure to below a certain level may increase IHD mortality is controversial. We investigated the influence of treated blood pressure on mortality in the DHSS Hypertension Care Computer Project. Mortality was examined by quintiles of treated diastolic blood pressure (DBP) in 2,145 patients treated for a minimum period of one year and subsequently followed for an average of four years. One hundred and seventy five patients died; 71 from IHD. In men and women all cause mortality increased with level of treated DBP. In men IHD mortality showed a U-shaped distribution with an age-adjusted rate of 15.2 per 1,000 person years in the lowest fifth (DBP less than 86 mmHg) comparable to that of 15.6 per 1,000 in the upper (DBP greater than or equal to 103 mmHg). A similar pattern could not be established in women due to very few IHD deaths. IHD mortality was further examined separately for men by prior history of IHD. An increase in IHD deaths in the lowest fifth of treated blood pressure was found for men both with and without a history of IHD. No similar pattern of IHD mortality was obtained for untreated DBP or treated systolic pressure. However, we cannot exclude the possibility that the risk of low treated DBP is secondary to ischaemic heart disease.
将血压降至某一特定水平可能会增加缺血性心脏病（IHD）死亡率这一观点存在争议。我们在卫生和社会保障部高血压护理计算机项目中研究了治疗后血压对死亡率的影响。对2145名接受治疗至少一年且随后平均随访四年的患者，按治疗后的舒张压（DBP）五分位数检查死亡率。175名患者死亡，其中71例死于IHD。在男性和女性中，所有原因导致的死亡率均随治疗后DBP水平升高而增加。在男性中，IHD死亡率呈U形分布，最低五分位数（DBP低于86 mmHg）的年龄调整死亡率为每1000人年15.2例，与最高五分位数（DBP大于或等于103 mmHg）的每1000人年15.6例相当。由于IHD死亡病例极少，在女性中未发现类似模式。根据IHD既往史对男性的IHD死亡率进行了进一步单独分析。在有和没有IHD病史的男性中，均发现治疗后血压最低五分位数的IHD死亡人数增加。对于未治疗的DBP或治疗后的收缩压，未获得类似的IHD死亡率模式。然而，我们不能排除治疗后DBP较低的风险继发于缺血性心脏病的可能性。
