Hebert P R, Fiebach N H, Eberlein K A, Taylor J O, Hennekens C H
Channing Laboratory, Department of Medicine, Harvard Medical School, Brookline, MA 02146.
Am J Epidemiol. 1988 Mar;127(3):581-90. doi: 10.1093/oxfordjournals.aje.a114833.
The value of pharmacologic treatment of mild-to-moderate hypertension remains controversial despite the availability of data from eight community-based randomized trials including over 34,000 subjects with entry diastolic blood pressures ranging from 85 to 120 mmHg. To obtain more reliable estimates of the effects of treatment, the authors conducted an overview of the data from all of these individual trials, and they found a significant 18% reduction in vascular mortality among subjects allocated to treatment, due chiefly to reductions in fatal stroke and myocardial infarction. Subjects allocated to treatment experienced highly significant reductions of approximately 40% in all stroke (typical odds ratio = 0.60, 95% confidence interval = 0.51-0.71) and fatal stroke (0.58, 0.44-0.77). For myocardial infarction, the proportional reductions were much smaller than those for stroke and were 9% for all and 8% for fatal events. While suggestive of protective effects, the typical odds ratios did not achieve statistical significance for either all (0.91, 0.82-1.01) or for fatal myocardial infarction (0.92, 0.78-1.08). This overview demonstrates a significant benefit of pharmacologic treatment of mild-to-moderate hypertension on vascular mortality and on all as well as fatal stroke. It also suggests possible benefits of treatment on all and fatal myocardial infarction which should be investigated further.
尽管已有八项基于社区的随机试验数据，涉及超过34000名舒张期血压在85至120 mmHg之间的受试者，但轻度至中度高血压药物治疗的价值仍存在争议。为了更可靠地评估治疗效果，作者对所有这些个体试验的数据进行了综述，发现接受治疗的受试者血管死亡率显著降低了18%，主要归因于致命性中风和心肌梗死的减少。接受治疗的受试者所有中风（典型优势比=0.60，95%置信区间=0.51 - 0.71）和致命性中风（0.58，0.44 - 0.77）显著降低约40%。对于心肌梗死，比例降低幅度远小于中风，所有心肌梗死降低9%，致命性心肌梗死降低8%。虽然提示有保护作用，但典型优势比在所有心肌梗死（0.91，0.82 - 1.01）或致命性心肌梗死（0.92，0.78 - 1.08）方面均未达到统计学显著性。该综述表明轻度至中度高血压药物治疗对血管死亡率、所有中风以及致命性中风有显著益处。它还提示治疗对所有心肌梗死和致命性心肌梗死可能有益，应进一步研究。
