Applegate W B, Pressel S, Wittes J, Luhr J, Shekelle R B, Camel G H, Greenlick M R, Hadley E, Moye L, Perry H M
University of Tennessee, Memphis.
Arch Intern Med. 1994 Oct 10;154(19):2154-60.
Little information has been published on the impact of antihypertensive medications on quality of life in older persons. Particular concern has existed that lowering systolic blood pressure in older persons might have adverse consequences on cognition, mood, or leisure activities.
A multicenter double-blind randomized controlled trial was conducted over an average of 5 years' followup involving 16 academic clinical trial clinics. Participants consisted of 4736 persons (1.06%) selected from 447,921 screenees aged 60 years and older. Systolic blood pressure at baseline ranged from 160 to 219 mm Hg, while diastolic blood pressure was less than 90 mm Hg. Participants were randomized to active antihypertensive drug therapy or matching placebo. Active treatment consisted of 12.5 to 25 mg of chlorthalidone for step 1, while step 2 consisted of 25 to 50 mg of atenolol. If atenolol was contraindicated, 0.05 to 0.10 mg of reserpine could be used for the second-step drug. The impact of drug treatment on measures of cognitive, emotional, and physical function and leisure activities was assessed.
Our analyses demonstrate that active treatment of isolated systolic hypertension in the Systolic Hypertension in the Elderly Program cohort had no measured negative effects and, for some measures, a slight positive effect on cognitive, physical, and leisure function. The positive findings in favor of the treatment group were small. There was no effect on measures related to emotional state. Measures of cognitive and emotional function were stable in both groups for the duration of the study. Both treatment groups showed a modest trend toward deterioration of some measures of physical and leisure function over the study period.
The overall study cohort exhibited decline over time in activities of daily living, particularly the more strenuous ones, and some decline in certain leisure activities. However, mood, cognitive function, basic self-care, and moderate leisure activity were remarkably stable for both the active and the placebo groups throughout the entire study. Results of this study support the inference that medical treatment of isolated systolic hypertension does not cause deterioration in measures of cognition, emotional state, physical function, or leisure activities.
关于抗高血压药物对老年人生活质量的影响，已发表的信息较少。人们特别担心降低老年人的收缩压可能会对认知、情绪或休闲活动产生不良后果。
在16个学术临床试验诊所进行了一项多中心双盲随机对照试验，平均随访5年。参与者包括从447921名60岁及以上的筛查对象中选出的4736人（1.06%）。基线收缩压范围为160至219毫米汞柱，舒张压低于90毫米汞柱。参与者被随机分为接受积极抗高血压药物治疗或匹配的安慰剂。第一步积极治疗包括12.5至25毫克氯噻酮，第二步包括25至50毫克阿替洛尔。如果阿替洛尔禁忌，第二步药物可使用0.05至0.10毫克利血平。评估了药物治疗对认知、情绪和身体功能及休闲活动指标的影响。
我们的分析表明，老年收缩期高血压计划队列中单纯收缩期高血压的积极治疗没有测量到负面影响，并且对于某些指标，对认知、身体和休闲功能有轻微的积极影响。支持治疗组的积极发现很小。对与情绪状态相关的指标没有影响。在研究期间，两组的认知和情绪功能指标都保持稳定。两个治疗组在研究期间某些身体和休闲功能指标都有适度的恶化趋势。
整个研究队列随着时间推移在日常生活活动中出现下降，尤其是更剧烈的活动，并且某些休闲活动也有一些下降。然而，在整个研究过程中，积极治疗组和安慰剂组的情绪、认知功能、基本自我护理和适度休闲活动都非常稳定。本研究结果支持这样的推断，即单纯收缩期高血压的药物治疗不会导致认知、情绪状态、身体功能或休闲活动指标的恶化。
