Fagerberg B, Wikstrand J, Berglund G, Samuelsson O, Agewall S
Department of Medicine, Sahlgrenska University Hospital, Göteborg University, Gothenburg, Sweden.
Am J Hypertens. 1998 Jan;11(1 Pt 1):14-22. doi: 10.1016/s0895-7061(97)00363-4.
The aim was to examine the feasibility and efficacy of a multifactorial risk factor intervention program in hypertensive patients at high cardiovascular risk. Treated hypertensive men, aged 50 to 72 years, with at least one of the following: serum cholesterol concentration > or = 6.5 mmol/L, diabetes mellitus, or smoking were randomized to multifactorial risk factor intervention (n = 253) or usual care (n = 255). The specific intervention was based on group meetings to encourage a lipid lowering diet and smoking cessation. Cholestyramine, nicotinic acid, fibrates, and later statins were used either as single drug therapy or in combination, following agreed guidelines in patients in whom the nonpharmacological intervention was judged to be insufficient. Usual care was given according to clinical practice. The median follow-up time was 6.6 years. Sixty-four patients (25.1%) died in the usual care group, compared with 41 patients (16.2%) in the intervention group (P = .016; 95% confidence interval, relative risk 0.42 to 0.92). The overall risk for fatal and nonfatal cardiovascular events was 29% lower in the intervention group than in the usual care group (P = .041). Relative to usual care, the intervention program lowered mean in-trial serum concentrations of total cholesterol (6.3%, P < .0001), LDL cholesterol (9.1%, P < .0001), and blood glucose (0.2 mmol/L, P < .05). Among smokers, at entry, cotinine-adjusted quit rates were 28% in the intervention group and 11% in the usual care group (P = .012) after 3 years. This study illustrates the very high cardiovascular risk in hypertensive patients 50 to 72 years of age with additional risk factors. The results indicate, however, that the gloomy prognosis may be improved by a dedicated risk factor intervention program.
目的是检验多因素风险因素干预方案在心血管疾病高风险高血压患者中的可行性和疗效。选取年龄在50至72岁之间、接受治疗的高血压男性患者，他们至少具备以下一项特征：血清胆固醇浓度≥6.5 mmol/L、糖尿病或吸烟，将其随机分为多因素风险因素干预组（n = 253）和常规治疗组（n = 255）。具体干预措施基于小组会议，鼓励采用降血脂饮食并戒烟。胆酸螯合剂、烟酸、贝特类药物，以及后来的他汀类药物，在非药物干预被判定不足的患者中，按照商定的指南，单独或联合使用。常规治疗按照临床实践进行。中位随访时间为6.6年。常规治疗组有64名患者（25.1%）死亡，而干预组有41名患者（16.2%）死亡（P = 0.016；95%置信区间，相对风险0.42至0.92）。干预组发生致命和非致命心血管事件的总体风险比常规治疗组低29%（P = 0.041）。相对于常规治疗，干预方案降低了试验期间总胆固醇的平均血清浓度（6.3%，P < 0.0001）、低密度脂蛋白胆固醇（9.1%，P < 0.0001）以及血糖（0.2 mmol/L，P < 0.05）。在吸烟者中，入组时，干预组经可替宁校正的戒烟率在3年后为28%，常规治疗组为11%（P = 0.012）。本研究表明，50至72岁有额外风险因素的高血压患者心血管疾病风险极高。然而，结果表明，通过专门的风险因素干预方案可能改善这种悲观的预后。
