Isles C G, Walker L M, Beevers G D, Brown I, Cameron H L, Clarke J, Hawthorne V, Hole D, Lever A F, Robertson J W
J Hypertens. 1986 Apr;4(2):141-56. doi: 10.1097/00004872-198604000-00003.
The mortality of 3783 non-malignant hypertensive patients attending the Glasgow Blood Pressure Clinic between 1968 and 1983 and followed for an average of 6.5 years was compared with that in three control groups: the general population of Strathclyde a group of 15 422 subjects aged 45-64 years and screened in Renfrew and Paisley between 1972 and 1976, and a group of hypertensives seen in a blood pressure clinic based on general practice in Renfrew. Average blood pressure for men at entry to the Glasgow Clinic was 181/111 mmHg falling to 158/96 mmHg during treatment. Corresponding values for women were 185/109 mmHg and 161/96 mmHg. Seven hundred and fifty clinic patients (451 males) died during follow-up, the commonest causes of death in both sexes being myocardial infarction and stroke. All-cause age-adjusted mortality (deaths per 1000 patient-years) was 41.4 for men and 22.1 for women. At all ages in both sexes and for all levels of initial blood pressure mortality was less in patients whose blood pressure was reduced most. Without a randomized control group it is not certain that lower mortality in those with well controlled blood pressure was due to treatment, although this is the most likely explanation. Cigarette smoking, a history of myocardial infarction, angina or stroke, retinal arterio-venous nipping, raised blood urea, an abnormal electrocardiogram (ECG) and secondary hypertension were associated with increased risk, but heavy alcohol intake, obesity, haematocrit greater than 45%, hypokalaemia and social class were not. Life table analysis showed that, despite some reduction of mortality by treatment, the relative risk to men and women in the clinic remained two- to five-times that of the general population. The benefits of treatment were not such as to restore normal expectation of life even when blood pressure was well controlled. Excess mortality in the clinic could not be explained by difference of smoking habit or social class. This suggests that there is in the hypertensive patients of the Glasgow Clinic an element of irreducible risk, that treatment may be beneficial in some respects but harmful in others, or that patients at particularly high risk are selectively referred to the clinic.
1968年至1983年间，3783名前往格拉斯哥血压诊所就诊的非恶性高血压患者接受了平均6.5年的随访，其死亡率与三个对照组进行了比较：斯特拉斯克莱德的普通人群、1972年至1976年间在伦弗鲁和佩斯利筛查的15422名45至64岁的受试者组成的一组，以及在伦弗鲁基于全科医疗的血压诊所就诊的一组高血压患者。进入格拉斯哥诊所时，男性的平均血压为181/111 mmHg，治疗期间降至158/96 mmHg。女性的相应数值为185/109 mmHg和161/96 mmHg。750名诊所患者（451名男性）在随访期间死亡，男女最常见的死亡原因是心肌梗死和中风。全因年龄调整死亡率（每1000患者年的死亡人数）男性为41.4，女性为22.1。在所有年龄段的男女中，以及在所有初始血压水平上，血压降低最多的患者死亡率较低。由于没有随机对照组，虽然这是最有可能的解释，但血压控制良好者死亡率较低是否归因于治疗尚不确定。吸烟、有心肌梗死、心绞痛或中风病史、视网膜动静脉交叉压迫、血尿素升高、心电图（ECG）异常和继发性高血压与风险增加相关，但大量饮酒、肥胖、血细胞比容大于45%、低钾血症和社会阶层则无关。生命表分析表明，尽管治疗使死亡率有所降低，但诊所中男性和女性的相对风险仍是普通人群的两到五倍。即使血压得到良好控制，治疗的益处也不足以恢复正常的预期寿命。诊所中过高的死亡率无法用吸烟习惯或社会阶层的差异来解释。这表明，格拉斯哥诊所的高血压患者存在不可降低的风险因素，治疗在某些方面可能有益，但在其他方面可能有害，或者是特别高危的患者被选择性地转诊到了该诊所。
