Davidson R A, Caranasos G J
Department of Medicine, University of Florida, Gainesville 32610.
Arch Intern Med. 1987 Nov;147(11):1933-7.
Clinical trials for over 15 years have addressed the therapeutic utility of treating elderly hypertensives. Many early trials showed no treatment effects. Because of the recent publication of new information, a review of available evidence concerning this issue was undertaken. Eight randomized clinical trials were assessed regarding trial design. The studies varied according to generalizability, diagnostic criteria, choice of therapy, outcome measures assessed, evaluation of compliance, methods of analysis, duration of follow-up, determination of side effects, and ability to exclude a type 2 error. While many of the earlier studies found no treatment effects, they lacked methodologic rigor; more recent studies demonstrated positive treatment effects. Pooling of results from similar trials supports a notable treatment effect in the prevention of stroke. There is also evidence that the elderly are not more susceptible to side effects of antihypertensive drugs, as is generally believed. The best evidence suggests the hypertensive elderly should be treated.
15年多来的临床试验探讨了治疗老年高血压患者的治疗效用。许多早期试验未显示出治疗效果。由于最近有新信息发表，因此对有关该问题的现有证据进行了综述。对八项随机临床试验的试验设计进行了评估。这些研究在可推广性、诊断标准、治疗选择、评估的结局指标、依从性评估、分析方法、随访持续时间、副作用的确定以及排除II型错误的能力等方面存在差异。虽然许多早期研究未发现治疗效果，但它们缺乏方法学上的严谨性；最近的研究显示出了积极的治疗效果。对类似试验结果的汇总支持在预防中风方面有显著的治疗效果。也有证据表明，老年人并不像普遍认为的那样更容易受到抗高血压药物副作用的影响。最佳证据表明，老年高血压患者应该接受治疗。
