Román O, Cuevas G, Bunout D
Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Rev Med Chil. 1998 Jul;126(7):745-52.
The V JNC consensus stated that although new antihypertensive agents, such as angiotensin converting enzyme inhibitors and calcium channel blockers, are considered safer drugs, there is no firm evidence from large controlled trials that these drugs are associated with a lower cardiovascular mortality.
To study the association between cardiovascular risk factors, blood pressure levels, pharmacological treatment and mortality in a group of hypertensive patients followed at an hypertension outpatient clinic.
Patients with essential hypertension were treated with different antihypertensive medications, according to physicians criteria, and controlled until death or loss from follow up. Causes of death were obtained from hospital records and death certificates. Survival was analyzed using life tables, comparisons between groups of patients were done using chi square or a Cox's proportional hazards model.
Three hundred thirty-nine hypertensive patients aged 33 to 80 years old were followed for a mean period of 9.8 +/- 4.9 years. Eighty-six were treated with beta blockers, 64 with diuretics, 133 with calcium antagonists and 56 with ACE inhibitors. Blood pressure dropped similarly with all medications. During follow up, 79 patients died. Life table analysis showed that patients with a history of angina, diabetes or myocardial infarction had higher mortality rates. Similarly, patients treated with beta blockers and diuretics had higher mortality than patients treated with calcium antagonists or angiotensin converting enzyme inhibitors. The proportional hazards model showed that the effect of treatment modality persisted after correction for the other risk factors for mortality.
In this series of hypertensive patients, those treated with beta blockers or diuretics had higher mortality rates than those receiving calcium channel antagonists or angiotensin converting enzyme inhibitors.
美国国家联合委员会（JNC）的共识指出，尽管新型抗高血压药物，如血管紧张素转换酶抑制剂和钙通道阻滞剂，被认为是更安全的药物，但大型对照试验中尚无确凿证据表明这些药物与较低的心血管死亡率相关。
研究在高血压门诊随访的一组高血压患者中，心血管危险因素、血压水平、药物治疗与死亡率之间的关联。
原发性高血压患者根据医生的标准接受不同的抗高血压药物治疗，并进行控制直至死亡或失访。死亡原因从医院记录和死亡证明中获取。使用生命表分析生存率，使用卡方检验或Cox比例风险模型对患者组之间进行比较。
339例年龄在33至80岁的高血压患者平均随访9.8±4.9年。86例接受β受体阻滞剂治疗，64例接受利尿剂治疗，133例接受钙拮抗剂治疗，56例接受血管紧张素转换酶抑制剂治疗。所有药物治疗后血压下降情况相似。随访期间，79例患者死亡。生命表分析显示，有心绞痛、糖尿病或心肌梗死病史的患者死亡率较高。同样，接受β受体阻滞剂和利尿剂治疗的患者死亡率高于接受钙拮抗剂或血管紧张素转换酶抑制剂治疗的患者。比例风险模型显示，在对其他死亡危险因素进行校正后，治疗方式的影响依然存在。
在这组高血压患者中，接受β受体阻滞剂或利尿剂治疗的患者死亡率高于接受钙通道拮抗剂或血管紧张素转换酶抑制剂治疗的患者。
