Liu L, Wang J G, Gong L, Liu G, Staessen J A
Hypertension Division, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
J Hypertens. 1998 Dec;16(12 Pt 1):1823-9. doi: 10.1097/00004872-199816120-00016.
Isolated systolic hypertension occurs in around 8% of Chinese people aged 60 years or older. In 1988, the Systolic Hypertension in China (Syst-China) Collaborative Group started to investigate whether active treatment could reduce the incidence of stroke and other cardiovascular complications in older patients with isolated systolic hypertension.
All patients were initially started on masked placebo. After stratification for centre, sex and previous cardiovascular complications, alternate patients (n=1253) were assigned nitrendipine at 10-40 mg daily, with the addition of captopril at 12.5-50.0 mg daily or hydrochlorothiazide at 12.5-50.0 mg daily, or both, if a sufficient blood pressure fall was not obtained. In the remaining 1141 control patients, matching placebos were administered similarly.
At entry, sitting blood pressure averaged 170.5 mmHg systolic and 86.0 mmHg diastolic, age averaged 66.5 years and total serum cholesterol was 5.1 mmol/l. After 2 years of follow-up, sitting systolic and diastolic blood pressures had fallen by 10.9 mmHg and 1.9 mmHg in the placebo group and by 20.0 mmHg and 5.0 mmHg in the active treatment group. The intergroup differences were 9.1 mmHg systolic (95% confidence interval 7.6-10.7 mmHg ) and 3.2 mmHg diastolic (95% confidence interval 2.4-4.0). Active treatment reduced total strokes by 38% (from 20.8 to 13.0 endpoints per 1000 patient-years, P=0.01), all-cause mortality by 39% (from 28.4 to 17.4 endpoints per 1000 patient-years, P=0.003), cardiovascular mortality by 39% (from 15.2 to 9.4 endpoints per 1000 patient-years, P=0.03), stroke mortality by 58% (from 6.9 to 2.9 endpoints per 1000 patient-years, P=0.02), and ail fatal and nonfatal cardiovascular endpoints by 37% (from 33.3 to 21.4 endpoints per 1000 patient-years, P=0.004).
Antihypertensive treatment prevents stroke and other cardiovascular complications in older Chinese patients with isolated systolic hypertension. Treatment of 1000 Chinese patients for 5 years could prevent 55 deaths, 39 strokes or 59 major cardiovascular endpoints.
60岁及以上的中国人中，约8%患有单纯收缩期高血压。1988年，中国收缩期高血压研究协作组（Syst-China）开始研究积极治疗是否能降低老年单纯收缩期高血压患者中风及其他心血管并发症的发生率。
所有患者最初均接受盲法安慰剂治疗。在按中心、性别和既往心血管并发症进行分层后，将交替的患者（n = 1253）分配接受每日10 - 40毫克的硝苯地平治疗，若血压降幅不足，则加用每日12.5 - 50.0毫克的卡托普利或每日12.5 - 50.0毫克的氢氯噻嗪，或两者并用。在其余1141名对照患者中，同样给予匹配的安慰剂。
入组时，坐位收缩压平均为170.5 mmHg，舒张压平均为86.0 mmHg，平均年龄为66.5岁，总血清胆固醇为5.1 mmol/l。经过2年的随访，安慰剂组坐位收缩压和舒张压分别下降了10.9 mmHg和1.9 mmHg，积极治疗组分别下降了20.0 mmHg和5.0 mmHg。组间差异为收缩压9.1 mmHg（95%置信区间7.6 - 10.7 mmHg），舒张压3.2 mmHg（95%置信区间2.4 - 4.0）。积极治疗使总中风发生率降低了38%（从每1000患者年20.8例终点事件降至13.0例，P = 0.01），全因死亡率降低了39%（从每1000患者年28.4例终点事件降至17.4例，P = 0.003），心血管死亡率降低了39%（从每1000患者年15.2例终点事件降至9.4例，P = 0.03），中风死亡率降低了58%（从每1000患者年6.9例终点事件降至2.9例，P = 0.02），所有致命和非致命心血管终点事件降低了37%（从每1000患者年33.3例终点事件降至21.4例，P = 0.004）。
降压治疗可预防老年中国单纯收缩期高血压患者的中风及其他心血管并发症。对1000名中国患者进行5年治疗可预防55例死亡、39例中风或59例主要心血管终点事件。
