Mulrow C D, Cornell J A, Herrera C R, Kadri A, Farnett L, Aguilar C
Geriatric Research, Education and Clinical Center, Audie L. Murphy Memorial Veterans Hospital, San Antonio, TX 78284.
JAMA. 1994 Dec 28;272(24):1932-8.
To estimate morbidity and mortality benefits of drug therapy for hypertensive elderly subjects, compare these benefits with effects in younger subjects, and provide a framework for generalizing results derived from trials to actual patients.
A literature search using MEDLINE from 1966 to 1993, references from reviews and trial articles, and experts.
Randomized trials lasting at least 1 year that evaluated effects of drug treatment on morbidity and mortality outcomes in hypertensive persons.
Four independent reviewers appraised protocol characteristics and quality of selected trials.
There were 13 trials involving 16,564 elderly persons (age 60 years and older). The prevalence of cardiovascular risk factors, cardiovascular disease, and competing comorbid diseases was lower among trial participants than the general population of hypertensive elderly persons. When the six large high-quality trials were combined, trial results showed 43 subjects (95% confidence interval [CI], 31 to 69) and 61 subjects (95% CI, 39 to 141) needed to be treated for 5 years to prevent one cerebrovascular event and one coronary heart disease event, respectively. Including the other seven trials did not change the results significantly. Only 18 subjects (95% CI, 14 to 25) needed to be treated to prevent one cardiovascular event (cerebrovascular or cardiac). Twelve trials in primarily younger and middle-aged adults involved approximately 33,000 persons. For all outcomes except cardiac mortality, two to four times as many of the younger subjects as the older subjects needed to be treated for 5 years to prevent morbid and mortal events. No significant effect on cardiac mortality was seen among younger subjects, while 78 older subjects (95% CI, 50 to 180) needed to be treated to prevent a fatal cardiac event.
Randomized trials demonstrate that treating healthy older persons with hypertension is highly efficacious. Five-year morbidity and mortality benefits derived from trials are greater for older than younger subjects. Extrapolating benefits from trials to individual patients is difficult, but should take into account multiple issues including the patient's risk factors, preexisting cardiovascular disease, and competing comorbid illnesses.
评估药物治疗对老年高血压患者发病率和死亡率的益处，将这些益处与年轻患者的治疗效果进行比较，并提供一个框架，以便将试验结果推广至实际患者。
使用MEDLINE对1966年至1993年的文献进行检索，参考综述和试验文章的参考文献，并咨询专家。
持续至少1年的随机试验，评估药物治疗对高血压患者发病率和死亡率结局的影响。
四名独立评审员评估所选试验的方案特征和质量。
有13项试验涉及16564名老年人（年龄60岁及以上）。试验参与者中心血管危险因素、心血管疾病和其他并存疾病的患病率低于老年高血压患者的总体人群。当合并六项大型高质量试验时，试验结果显示，分别需要治疗43名受试者（95%置信区间[CI]，31至69）和61名受试者（95%CI，39至141）达5年，以预防一次脑血管事件和一次冠心病事件。纳入其他七项试验并未显著改变结果。仅需治疗18名受试者（95%CI，14至25）即可预防一次心血管事件（脑血管或心脏事件）。主要针对年轻和中年成年人的12项试验涉及约33000人。对于除心脏死亡率以外的所有结局，年轻受试者预防发病和死亡事件所需接受5年治疗的人数是老年受试者的两到四倍。年轻受试者中未观察到对心脏死亡率有显著影响，而预防致命心脏事件则需要治疗78名老年受试者（95%CI，50至180）。
随机试验表明，治疗健康的老年高血压患者非常有效。试验得出的5年发病率和死亡率益处，老年患者比年轻患者更大。将试验益处外推至个体患者很困难，但应考虑多个问题，包括患者的危险因素、已有的心血管疾病和其他并存疾病。
