Kostis J B, Davis B R, Cutler J, Grimm R H, Berge K G, Cohen J D, Lacy C R, Perry H M, Blaufox M D, Wassertheil-Smoller S, Black H R, Schron E, Berkson D M, Curb J D, Smith W M, McDonald R, Applegate W B
Department of Medicine, Center for Disease Management and Clinical Outcomes, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA.
JAMA. 1997 Jul 16;278(3):212-6.
Heart failure is often preceded by isolated systolic hypertension, but the effectiveness of antihypertensive treatment in preventing heart failure is not known.
To assess the effect of diuretic-based antihypertensive stepped-care treatment on the occurrence of heart failure in older persons with isolated systolic hypertension.
Analysis of data from a multicenter, randomized, double-blind, placebo-controlled clinical trial.
A total of 4736 persons aged 60 years and older with systolic blood pressure between 160 and 219 mm Hg and diastolic blood pressure below 90 mm Hg who participated in the Systolic Hypertension in the Elderly Program (SHEP).
Stepped-care antihypertensive drug therapy, in which the step 1 drug is chlorthalidone (12.5-25 mg) or matching placebo, and the step 2 drug is atenolol (25-50 mg) or matching placebo.
Fatal and nonfatal heart failure.
During an average of 4.5 years of follow-up, fatal or nonfatal heart failure occurred in 55 of 2365 patients randomized to active therapy and 105 of the 2371 patients randomized to placebo (relative risk [RR], 0.51; 95% confidence interval [CI], 0.37-0.71; P<.001; number needed to treat to prevent 1 event [NNT], 48). Among patients with a history of or electrocardiographic evidence of prior myocardial infarction (MI), the RR was 0.19 (95% CI, 0.06-0.53; P=.002; NNT, 15). Older patients, men, and those with higher systolic blood pressure or a history of or electrocardiographic evidence of MI at baseline had higher risk of developing heart failure.
In older persons with isolated systolic hypertension, stepped-care treatment based on low-dose chlorthalidone exerted a strong protective effect in preventing heart failure. Among patients with prior MI, an 80% risk reduction was observed.
心力衰竭常先于单纯收缩期高血压出现，但抗高血压治疗在预防心力衰竭方面的有效性尚不清楚。
评估基于利尿剂的抗高血压阶梯式治疗对老年单纯收缩期高血压患者发生心力衰竭的影响。
对一项多中心、随机、双盲、安慰剂对照临床试验的数据进行分析。
共有4736名年龄在60岁及以上、收缩压在160至219毫米汞柱之间且舒张压低于90毫米汞柱的人参与了老年收缩期高血压计划（SHEP）。
阶梯式抗高血压药物治疗，其中第1步药物为氯噻酮（12.5 - 25毫克）或匹配的安慰剂，第2步药物为阿替洛尔（25 - 50毫克）或匹配的安慰剂。
致命性和非致命性心力衰竭。
在平均4.5年的随访期间，随机分配到积极治疗组的2365名患者中有55人发生致命或非致命性心力衰竭，随机分配到安慰剂组的2371名患者中有105人发生（相对风险[RR]，0.51；95%置信区间[CI]，0.37 - 0.71；P <.001；预防1例事件所需治疗人数[NNT]，48）。在有既往心肌梗死（MI）病史或心电图证据的患者中，RR为0.19（95% CI，0.06 - 0.53；P =.002；NNT，15）。老年患者、男性以及基线时收缩压较高或有MI病史或心电图证据的患者发生心力衰竭的风险更高。
在老年单纯收缩期高血压患者中，基于低剂量氯噻酮的阶梯式治疗在预防心力衰竭方面具有很强的保护作用。在既往有MI的患者中，观察到风险降低了80%。
