Gueyffier F, Boutitie F, Boissel J P, Pocock S, Coope J, Cutler J, Ekbom T, Fagard R, Friedman L, Perry M, Prineas R, Schron E
Claude Bernard University, Lyon, France.
Ann Intern Med. 1997 May 15;126(10):761-7. doi: 10.7326/0003-4819-126-10-199705150-00002.
Trials of drug therapy for hypertension have shown that such therapy has a clear overall benefit in preventing cardiovascular disease. Although these trials have included slightly more women than men, it is still not clear whether treatment benefit is similar for both sexes.
To quantify the average treatment effect in both sexes and to determine whether available data show significant differences in treatment effect between women and men.
Subgroup meta-analysis of individual patient data according to sex. Analysis was based on seven trials from the INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) database and was adjusted for possible confounders.
20,802 women and 19,975 men recruited between 1972 and 1990.
Primarily beta-blockers and thiazide diuretics.
In women, treatment effect was statistically significant for stroke (fatal strokes and all strokes) and for major cardiovascular events. In men, it was statistically significant for all categories of events (total and specific mortality, all coronary events, all strokes, and major cardiovascular events). The odds ratios for any category of event did not differ significantly between men and women. In absolute terms, the benefit in women was seen primarily for strokes; in men, treatment prevented as many coronary events as strokes. Graphical analyses suggest that these results could be completely explained by the difference in untreated risk.
In terms of relative risk, treatment benefit did not differ between women and men. The absolute risk reduction attributable to treatment seemed to depend on untreated risk. These findings underline the need to predict accurately the untreated cardiovascular risk of an individual person in order to rationalize and individualize antihypertensive treatment.
高血压药物治疗试验表明，此类治疗在预防心血管疾病方面具有明显的总体益处。尽管这些试验纳入的女性略多于男性，但治疗益处对两性是否相似仍不清楚。
量化两性的平均治疗效果，并确定现有数据是否显示男女在治疗效果上存在显著差异。
根据性别对个体患者数据进行亚组荟萃分析。分析基于印第安纳（INDANA，抗高血压干预试验个体数据分析）数据库中的七项试验，并对可能的混杂因素进行了调整。
1972年至1990年间招募的20802名女性和19975名男性。
主要为β受体阻滞剂和噻嗪类利尿剂。
在女性中，治疗对中风（致命性中风和所有中风）和主要心血管事件的效果具有统计学意义。在男性中，对所有事件类别（总死亡率和特定死亡率、所有冠心病事件、所有中风和主要心血管事件）均具有统计学意义。任何事件类别的优势比在男性和女性之间没有显著差异。从绝对值来看，女性的益处主要体现在中风方面；在男性中，治疗预防的冠心病事件与中风事件数量相同。图形分析表明，这些结果可以完全由未治疗风险的差异来解释。
就相对风险而言，男女的治疗益处没有差异。治疗所致的绝对风险降低似乎取决于未治疗风险。这些发现强调了准确预测个体未治疗心血管风险的必要性，以便使抗高血压治疗合理化并实现个体化。
