Cushman W C, Cutler J A, Hanna E, Bingham S F, Follmann D, Harford T, Dubbert P, Allender P S, Dufour M, Collins J F, Walsh S M, Kirk G F, Burg M, Felicetta J V, Hamilton B P, Katz L A, Perry H M, Willenbring M L, Lakshman R, Hamburger R J
Veterans Affairs Medical Center, Memphis, Tenn 38104, USA.
Arch Intern Med. 1998 Jun 8;158(11):1197-207. doi: 10.1001/archinte.158.11.1197.
To determine whether blood pressure is reduced for at least 6 months with an intervention to lower alcohol intake in moderate to heavy drinkers with above optimal to slightly elevated diastolic blood pressure, and whether reduction of alcohol intake can be maintained for 2 years.
A randomized controlled trial.
Six hundred forty-one outpatient veterans with an average intake of 3 or more alcoholic drinks per day in the 6 months before entry into the study and with diastolic blood pressure 80 to 99 mm Hg were randomly assigned to a cognitive-behavioral alcohol reduction intervention program or a control observation group for 15 to 24 months. The goal of the intervention was the lower of 2 or fewer drinks daily or a 50% reduction in intake. A subgroup with hypertension was defined as having a diastolic blood pressure of 90 to 99 mm Hg, or 80 to 99 mm Hg if recently taking medication for hypertension.
Reduction in average weekly self-reported alcohol intake was significantly greater (P<.001) at every assessment from 3 to 24 months in the intervention group vs the control group: levels declined from 432 g/wk at baseline by 202 g/wk in the intervention group and from 445 g/wk by 78 g/wk in the control group in the first 6 months, with similar reductions after 24 months. The intervention group had a 1.2/0.7-mm Hg greater reduction in blood pressure than the control group (for each, P = .17 and P = .18) for the 6-month primary end point; for the hypertensive stratum the difference was 0.9/0.7 mm Hg (for each, P = .58 and P = .44).
The 1.3 drinks per day average difference between changes in self-reported alcohol intake observed in this trial produced only small nonsignificant effects on blood pressure. The results from the Prevention and Treatment of Hypertension Study (PATHS) do not provide strong support for reducing alcohol consumption in nondependent moderate drinkers as a sole method for the prevention or treatment of hypertension.
确定对于舒张血压高于最佳值至轻度升高的中度至重度饮酒者，通过降低酒精摄入量的干预措施，血压是否能降低至少6个月，以及酒精摄入量的减少能否维持2年。
一项随机对照试验。
641名门诊退伍军人，在进入研究前6个月平均每天摄入3杯或更多酒精饮料，舒张血压为80至99毫米汞柱，被随机分配到认知行为酒精减少干预项目或对照观察组，为期15至24个月。干预的目标是每天饮用2杯或更少，或摄入量减少50%。高血压亚组定义为舒张血压为90至99毫米汞柱，或如果最近正在服用高血压药物，则为80至99毫米汞柱。
在干预组与对照组中，从3至24个月的每次评估中，自我报告的平均每周酒精摄入量减少显著更大（P<0.001）：干预组从基线时的432克/周在最初6个月内降至202克/周，对照组从445克/周降至78克/周，24个月后有类似的减少。对于6个月的主要终点，干预组的血压降低比对照组高1.2/0.7毫米汞柱（分别为P = 0.17和P = 0.18）；对于高血压阶层，差异为0.9/0.7毫米汞柱（分别为P = 0.58和P = 0.44）。
本试验中观察到的自我报告酒精摄入量变化的每天1.3杯平均差异，对血压仅产生微小的无显著意义的影响。高血压预防与治疗研究（PATHS）的结果并不强烈支持将减少非依赖型中度饮酒者的酒精消费作为预防或治疗高血压的唯一方法。
