Lever A F, Ramsay L E
MRC Blood Pressure Unit, Western Infirmary, Glasgow, UK.
J Hypertens. 1995 Jun;13(6):571-9. doi: 10.1097/00004872-199506000-00001.
The outcome of treatment in elderly hypertensives is examined in six major randomized controlled trials. Thiazide diuretics were first- or second-line drugs in each, and beta-blockers were first- or second-line drugs in four.
All compared immediate active treatment, with drugs added stepwise until blood pressure was controlled, versus withholding antihypertensive treatment unless blood pressure exceeded predetermined safety levels.
Because placebo-treated patients required active treatment and actively treated patients required more than one drug, benefits were underestimated and the comparisons were not of single drugs with each other or with placebo. The incidence of fatal stroke was reduced by 33%, of fatal coronary events by 26% and cardiovascular mortality by 22%. Because cardiovascular risk varied among the trial populations, the absolute benefit from treatment varied markedly.
In trials representative of unselected patients, treatment of diastolic hypertension might prevent cardiovascular complications in 1.4-2.2% of patients each year and fatal cardiovascular complications in 0.5-1.3% each year. In isolated systolic hypertension, treatment might prevent cardiovascular complications in 1.1% of patients each year. Generally, diuretic treatment proved superior to treatment with beta-blocker, and drugs of both types were well tolerated. There is a strong case for treating elderly hypertensives with a diuretic-based regimen.
在六项主要的随机对照试验中研究老年高血压患者的治疗结果。噻嗪类利尿剂在每项试验中均为一线或二线药物，β受体阻滞剂在四项试验中为一线或二线药物。
所有试验均比较了立即进行积极治疗（逐步添加药物直至血压得到控制）与除非血压超过预定安全水平否则不进行抗高血压治疗的情况。
由于接受安慰剂治疗的患者需要积极治疗，而接受积极治疗的患者需要不止一种药物，因此益处被低估，且比较并非单一药物之间或与安慰剂之间的比较。致命性中风的发生率降低了33%，致命性冠状动脉事件的发生率降低了26%，心血管死亡率降低了22%。由于试验人群的心血管风险各不相同，治疗的绝对益处差异显著。
在代表未选择患者的试验中，舒张期高血压的治疗每年可能预防1.4% - 2.2%的患者发生心血管并发症，每年预防0.5% - 1.3%的患者发生致命性心血管并发症。在单纯收缩期高血压中，治疗每年可能预防1.1%的患者发生心血管并发症。一般来说，利尿剂治疗优于β受体阻滞剂治疗，且两种类型的药物耐受性良好。有充分的理由采用以利尿剂为基础的方案治疗老年高血压患者。
