Dahlöf B, Hansson L, Lindholm L H, Scherstén B, Ekbom T, Wester P O
Department of Medicine, University of Göteborg, Ostra Hospital.
Clin Exp Hypertens. 1993 Nov;15(6):925-39. doi: 10.3109/10641969309037082.
Hypertension is increasingly common with advancing age and a risk factor for all kinds of cardiovascular complications. Moreover, cardiovascular disease is a major cause of morbidity and mortality in the elderly. The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was set up by the Swedish Hypertension Society to investigate the value of antihypertensive treatment in the elderly. In this placebo controlled randomised prospective study 1,627 men and women aged 70-84 years with a supine blood pressure > or = 180/105 mmHg (and/or) but not isolated systolic hypertension participated. Three beta-blockers and one diuretic were used as blood pressure lowering agents and the average follow-up in the study was 25 months (3,390 patient-years). Administration of active antihypertensive therapy, reduced supine blood pressure from 195/102 mmHg to 167/87 mmHg at longest follow-up in comparison with placebo. A majority of the patients needed combined treatment to reach the goal blood pressure (160/95 mmHg). Associated with a fall in blood pressure were significant reductions in all cardiovascular primary endpoints (-40%, p = 0.0031), in fatal and non-fatal stroke (-47%, p = 0.0081) and in total mortality (-43%, p = 0.0079). In addition to the substantial effects on primary endpoints active treatment also showed clinically relevant effects on secondary endpoints (e.g. heart failure). The impact on cardiovascular morbidity and mortality with antihypertensive treatment in this elderly cohort was greater than previously seen in middle-aged hypertensive patients, with maintained tolerability and a favourable cost-effectiveness ratio. Finally, women benefited from treatment at least as much as men.
高血压随着年龄增长日益常见，且是各类心血管并发症的危险因素。此外，心血管疾病是老年人发病和死亡的主要原因。瑞典老年高血压患者试验（STOP - 高血压试验）由瑞典高血压协会发起，旨在研究老年人抗高血压治疗的价值。在这项安慰剂对照的随机前瞻性研究中，1627名年龄在70 - 84岁、仰卧血压≥180/105 mmHg（和/或）但非单纯收缩期高血压的男性和女性参与其中。三种β受体阻滞剂和一种利尿剂被用作降压药物，研究的平均随访时间为25个月（3390患者 - 年）。与安慰剂相比，积极抗高血压治疗在最长随访时将仰卧血压从195/102 mmHg降至167/87 mmHg。大多数患者需要联合治疗才能达到目标血压（160/95 mmHg）。随着血压下降，所有心血管主要终点事件显著减少（-40%，p = 0.0031），致命和非致命性卒中减少（-47%，p = 0.0081），总死亡率减少（-43%，p = 0.0079）。除了对主要终点有显著影响外，积极治疗对次要终点（如心力衰竭）也显示出临床相关影响。在这个老年队列中，抗高血压治疗对心血管发病率和死亡率的影响大于先前在中年高血压患者中所见，且耐受性良好，成本效益比有利。最后，女性从治疗中获益至少与男性一样多。
