MacMahon S W, Cutler J A, Neaton J D, Furberg C D, Cohen J D, Kuller L H, Stamler J
J Hypertens Suppl. 1986 Dec;4(6):S14-7.
We compared pooled mortality and morbidity results from nine randomized trials of antihypertensive drug treatment (total n = 43,139), in which diastolic blood pressure (DBP) was reduced by a mean of 5.8 mmHg, with mortality and morbidity differences associated with the same DBP difference in two large prospective, observational studies [the follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT) screenees and the Framingham Study]. These results indicate that the effect on stroke of BP reduction in the trials (-36%, 95% confidence interval +/- 10%) was about 80% of that estimated from the epidemiological studies, suggesting that the effects of long-term BP elevation on the cerebral vasculature are mostly reversible over 5-6 years of BP reduction. For coronary heart disease (CHD), the effect of BP reduction in the trials (-9 +/- 10%) was about 36% of that estimated from the epidemiological studies. This difference may reflect chronic processes involved in the pathophysiological association of BP with CHD; however, selective treatment of control patients at high risk of CHD and an adverse effect of diuretics on serum cholesterol may have influenced the effect of treatment in the trials.
我们比较了九项抗高血压药物治疗随机试验（总计n = 43,139）的合并死亡率和发病率结果，这些试验中舒张压（DBP）平均降低了5.8 mmHg，并与两项大型前瞻性观察性研究[多重危险因素干预试验（MRFIT）筛查对象的随访研究和弗雷明汉研究]中相同DBP差值相关的死亡率和发病率差异进行了比较。这些结果表明，试验中血压降低对中风的影响（-36%，95%置信区间±10%）约为流行病学研究估计值的80%，这表明长期血压升高对脑血管系统的影响在血压降低5至6年期间大多是可逆的。对于冠心病（CHD），试验中血压降低的影响（-9±10%）约为流行病学研究估计值的36%。这种差异可能反映了血压与冠心病病理生理关联中涉及的慢性过程；然而，对冠心病高危对照患者的选择性治疗以及利尿剂对血清胆固醇的不良影响可能影响了试验中的治疗效果。
