Dahlöf B, Hansson L, Lindholm L H, Scherstén B, Wester P O, Ekbom T, Hedner T, de Faire U
Department of Medicine, University of Göteborg, Ostra Hospital, Sweden.
Blood Press. 1993 Jun;2(2):136-41. doi: 10.3109/08037059309077541.
It is well established that hypertensive patients benefit from drug treatment of their disorder. In recent years three major out-come studies of antihypertensive treatment in elderly hypertensives have shown substantial benefits, i.e. a reduction in the risk of stroke and other cardiovascular mortality and morbidity. In all these studies beta-blockers and/or diuretics were used in comparison with placebo. Newer therapeutic alternatives have, however, at least theoretically, many advantages which could result in further improvements in prognosis. The initial Swedish Trial in Old Patients with Hypertension (STOP-Hypertension 1) was conducted in men and women aged 70-84 years. STOP-Hypertension 2 will evaluate the therapy used in STOP-Hypertension 1 against therapy based on either ACE-inhibitors (enalapril and lisinopril) or on calcium antagonists (isradipine and felodipine), using the PROBE design (Prospective, Randomised, Open, Blinded Endpoint evaluation). The primary aim will be to assess the effect on cardiovascular mortality. Statistical calculations indicate that 6,600 patients, followed for four years will be needed (2p < 0.05, power 90%) to obtain significance if there is a 25% difference between the new and the established therapy. Patients in primary health care (300 centres) will be included if their supine blood pressure is > or = 180/105 mmHg (and/or). Recruitment of patients started in September 1992 and so far more than 100 patients/week have been included.
高血压患者通过药物治疗其疾病可获益，这一点已得到充分证实。近年来，针对老年高血压患者进行的三项主要抗高血压治疗结果研究显示出显著益处，即中风风险以及其他心血管疾病死亡率和发病率降低。在所有这些研究中，β受体阻滞剂和/或利尿剂与安慰剂进行了对比使用。然而，至少从理论上讲，更新的治疗选择具有许多优势，可能会进一步改善预后。最初的瑞典老年高血压患者试验（STOP - 高血压1）针对的是年龄在70 - 84岁的男性和女性。STOP - 高血压2将采用PROBE设计（前瞻性、随机、开放、盲终点评估），将STOP - 高血压1中使用的治疗方法与基于ACE抑制剂（依那普利和赖诺普利）或钙拮抗剂（伊拉地平和平尼地平）的治疗方法进行评估对比。主要目的将是评估对心血管疾病死亡率的影响。统计计算表明，如果新治疗方法与现有治疗方法之间存在25%的差异，那么需要对6600名患者进行为期四年的随访（双侧P < 0.05，检验效能90%）才能得出显著结果。如果初级卫生保健机构（300个中心）的患者仰卧血压≥180/105 mmHg（和/或），则将其纳入。患者招募于1992年9月开始，迄今为止，每周纳入的患者超过100名。
