Waller P C, Isles C G, Lever A F, Murray G D, McInnes G T
Glasgow Blood Pressure Clinic, Western Infirmary, UK.
J Hum Hypertens. 1988 Jun;2(1):7-10.
Mortality data from 3350 patients who attended the Glasgow Blood Pressure Clinic between 1968 and the end of 1982 were used to examine the hypothesis that lowering diastolic blood pressure (DBP) below 85 mmHg causes death from coronary heart disease (CHD). Analysis of 257 coronary deaths in quintiles of treated DBP showed a significantly nonlinear relation, with the lowest mortality from CHD occurring in the middle quintile (91-98 mmHg). This finding persisted after adjustment for risk at entry, and was independent of sex and pre-existing CHD. In contrast, the relations between treated systolic blood pressure and death from CHD, and treated DBP and death from stroke were linear. For 2355 patients who were untreated at referral there was no relation between the change in DBP during treatment and death from CHD. In our view, however, these findings do not necessarily support the hypothesis that lowering of DBP below 85 mmHg with treatment causes death from CHD. Evidence for this is indirect and inconsistent, and should not, at present, be used as a basis for any change in treatment practice.
利用1968年至1982年底期间在格拉斯哥血压诊所就诊的3350名患者的死亡率数据，来检验将舒张压（DBP）降至85 mmHg以下会导致冠心病（CHD）死亡这一假设。对按治疗后DBP五分位数划分的257例冠心病死亡病例进行分析，结果显示存在显著的非线性关系，冠心病死亡率最低的情况出现在中间五分位数（91 - 98 mmHg）。在对入院时的风险进行调整后，这一发现依然存在，且与性别和既往是否患有冠心病无关。相比之下，治疗后的收缩压与冠心病死亡之间的关系，以及治疗后的DBP与中风死亡之间的关系呈线性。对于2355例转诊时未接受治疗的患者，治疗期间DBP的变化与冠心病死亡之间没有关联。然而，我们认为，这些发现不一定支持通过治疗将DBP降至85 mmHg以下会导致冠心病死亡这一假设。支持这一假设的证据是间接且不一致的，目前不应将其作为改变治疗实践的依据。
