老年孤立收缩期高血压患者抗高血压药物治疗预防脑卒中老年收缩期高血压计划(SHEP)的最终结果。SHEP合作研究小组。必威国际app
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老年孤立收缩期高血压患者抗高血压药物治疗预防脑卒中老年收缩期高血压计划(SHEP)的最终结果。SHEP合作研究小组。必威国际app
《美国医学协会杂志》上。1991 6月26日;265(24):3255-64。
- PubMed ID
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2046107 (PubMed视图］
- 摘要
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目的:评估抗高血压药物治疗降低孤立收缩期高血压患者非致死性和致死性(全)卒中风险的能力。设计:多中心、随机、双盲、安慰剂对照。环境:三级保健中心的社区流动人口。参与者:从447,921名60岁及以上的筛查者中随机抽取4736人(1.06%)(2365人接受积极治疗，2371人接受安慰剂)。收缩压为160 - 219mmhg，舒张压小于90mmhg。在参与者中，3161人在初次接触时未接受抗高血压药物治疗，1575人接受了抗高血压药物治疗。平均收缩压170 mm Hg;平均舒张压77毫米汞柱。平均年龄72岁，57%为女性，14%为黑人。干预措施:参与者按临床中心和初次接触时的抗高血压药物状态进行分层。试验的第1步，剂量1为氯噻酮，12.5 mg/d，或匹配的安慰剂;剂量2为25 mg/d。 For step 2, dose 1 was atenolol, 25 mg/d, or matching placebo; dose 2 was 50 mg/d. MAIN OUTCOME MEASURES: Primary. Nonfatal and fatal (total) stroke. Secondary. Cardiovascular and coronary morbidity and mortality, all-cause mortality, and quality of life measures. RESULTS: Average follow-up was 4.5 years. The 5-year average systolic blood pressure was 155 mm Hg for the placebo group and 143 mm Hg for the active treatment group, and the 5-year average diastolic blood pressure was 72 and 68 mm Hg, respectively. The 5-year incidence of total stroke was 5.2 per 100 participants for active treatment and 8.2 per 100 for placebo. The relative risk by proportional hazards regression analysis was 0.64 (P = .0003). For the secondary end point of clinical nonfatal myocardial infarction plus coronary death, the relative risk was 0.73. Major cardiovascular events were reduced (relative risk, 0.68). For deaths from all causes, the relative risk was 0.87. CONCLUSION: In persons aged 60 years and over with isolated systolic hypertension, antihypertensive stepped-care drug treatment with low-dose chlorthalidone as step 1 medication reduced the incidence of total stroke by 36%, with 5-year absolute benefit of 30 events per 1000 participants. Major cardiovascular events were reduced, with 5-year absolute benefit of 55 events per 1000.
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