Messerli F H, Grossman E, Goldbourt U
Department of Internal Medicine, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA 70121, USA.
JAMA. 1998 Jun 17;279(23):1903-7. doi: 10.1001/jama.279.23.1903.
To assess antihypertensive efficacy of beta-blockers and their effects on cardiovascular morbidity and mortality and all-cause morbidity compared with diuretics in elderly patients with hypertension.
A MEDLINE search of English-language articles published between January 1966 and January 1998 using the terms hypertension (drug therapy) and elderly or aged or geriatric, and cerebrovascular or cardiovascular diseases, and morbidity or mortality. References from identified articles were also reviewed.
Randomized trials lasting at least 1 year, which used as first-line agents diuretics and/or beta-blockers, and reported morbidity and mortality outcomes in elderly patients with hypertension. DATA SYNTHESIS AND RESULTS: Ten trials involving a total of 16164 elderly patients (> or =60 years) were included. Two thirds of the patients assigned to diuretics were well controlled on monotherapy, whereas less than a third of the patients assigned to beta-blockers were well controlled on monotherapy. Diuretic therapy was superior to beta-blockade with regard to all end points and was effective in preventing cerebrovascular events (odds ratio [OR], 0.61; 95% confidence interval [CI], 0.51-0.72), fatal stroke (OR, 0.67; 95% CI, 0.49-0.90), coronary heart disease (OR, 0.74; 95% CI, 0.64-0.85), cardiovascular mortality (OR, 0.75; 95% CI, 0.64-0.87), and all-cause mortality (OR, 0.86; 95% CI, 0.77-0.96). In contrast, beta-blocker therapy only reduced the odds for cerebrovascular events (OR, 0.75; 95% CI, 0.57-0.98) but was ineffective in preventing coronary heart disease, cardiovascular mortality, and all-cause mortality (ORs, 1.01, 0.98, and 1.05, respectively).
In contrast to diuretics, which remain the standard first-line therapy, beta-blockers, until proven otherwise, should no longer be considered appropriate first-line therapy of uncomplicated hypertension in the elderly hypertensive patient.
评估β受体阻滞剂在老年高血压患者中的降压疗效及其对心血管疾病发病率、死亡率和全因发病率的影响，并与利尿剂进行比较。
利用“高血压（药物治疗）”以及“老年人”或“老年”或“老年病学”，还有“脑血管或心血管疾病”以及“发病率或死亡率”等检索词，对1966年1月至1998年1月发表的英文文章进行MEDLINE检索。还对已识别文章的参考文献进行了审查。
持续至少1年的随机试验，试验将利尿剂和/或β受体阻滞剂用作一线药物，并报告老年高血压患者的发病率和死亡率结果。数据综合与结果：纳入了10项试验，共涉及16164名老年患者（≥60岁）。分配到利尿剂组的患者中有三分之二单药治疗控制良好，而分配到β受体阻滞剂组的患者中只有不到三分之一单药治疗控制良好。在所有终点方面，利尿剂治疗均优于β受体阻滞剂治疗，且在预防脑血管事件（优势比[OR]，0.61；95%置信区间[CI]，0.51 - 0.72）、致命性卒中（OR，0.67；95% CI，0.49 - 0.90）、冠心病（OR，0.74；95% CI，0.64 - 0.85）、心血管死亡率（OR，0.75；95% CI，0.64 - 0.87）和全因死亡率（OR，0.86；95% CI，0.77 - 0.96）方面有效。相比之下，β受体阻滞剂治疗仅降低了脑血管事件的发生几率（OR，0.75；95% CI，0.57 - 0.98），但在预防冠心病、心血管死亡率和全因死亡率方面无效（OR分别为1.01、0.98和1.05）。
与仍然是标准一线治疗药物的利尿剂不同，在未得到其他证据证明之前，β受体阻滞剂不应再被视为老年高血压患者单纯性高血压的合适一线治疗药物。
