NEJM：老年高血压新疗法

中国有超过一千三百万八十岁以上老人，其中百分之五十一以上患有高血压，但对他们使用降压治疗是否可获得明确益处，一直是临床医生困惑的问题。最新公布的一项全球最大规模老年高血压降压治疗前瞻性研究结果解决了这一难题。

由世界高血压联盟主席、中国著名专家刘力生教授指导，中国内地一千五百二十六位中国患者参加的这项全球大型研究共收入十三个国家的三千八百四十五例高血压患者，以降低收缩压和舒张压分别达到150mmHg和80mmHg为目标，经过五年的观察证实，以吲达帕胺缓释片(纳催离缓释片)为基础，必要时加用培哚普利(雅施达)的降压方案，在降压的同时显著降低了老年高血压患者的全因死亡率和卒中死亡率分别达百分之二十一和三十九，并显著降低致死性和非致死性心衰百分之六十四，降低心血管事件百分之三十四，且未出现明显的不良事件。

专家指出，利尿剂吲达帕胺是中国广泛应用的降压药之一，但本研究采用施维雅公司研发的创新剂型吲达帕胺缓释片剂量小，可二十四小时平稳降压且安全性高，是各国临床指南惟一推荐的缓释利尿剂。

该项研究的主要负责人伦敦皇家学院老年医学部布尔皮特教授称，研究结果“可实现对老年高血压患者通过降压治疗延长生命的医患共同愿望”。第五十七届美国心脏学院学会年会和《新英格兰医学杂志》（NEJM）同时发表了该研究成果 。（来源：中新网 曾利明）

原始出处：

（NEJM），doi：10.1056/NEJMoa0801369，Lisheng Liu，Christopher J. Bulpitt

Treatment of Hypertension in Patients 80 Years of Age or Older

Nigel S. Beckett, M.B., Ch.B., Ruth Peters, Ph.D., Astrid E. Fletcher, Ph.D., Jan A. Staessen, M.D., Ph.D., Lisheng Liu, M.D., Dan Dumitrascu, M.D., Vassil Stoyanovsky, M.D., Riitta L. Antikainen, M.D., Ph.D., Yuri Nikitin, M.D., Craig Anderson, M.D., Ph.D., Alli Belhani, M.D., Françoise Forette, M.D., Chakravarthi Rajkumar, M.D., Ph.D., Lutgarde Thijs, M.Sc., Winston Banya, M.Sc., Christopher J. Bulpitt, M.D., for the HYVET Study Group
 
ABSTRACT
Background Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear. It has been suggested that antihypertensive therapy may reduce the risk of stroke, despite possibly increasing the risk of death.

Methods We randomly assigned 3845 patients from Europe, China, Australasia, and Tunisia who were 80 years of age or older and had a sustained systolic blood pressure of 160 mm Hg or more to receive either the diuretic indapamide (sustained release, 1.5 mg) or matching placebo. The angiotensin-converting–enzyme inhibitor perindopril (2 or 4 mg), or matching placebo, was added if necessary to achieve the target blood pressure of 150/80 mm Hg. The primary end point was fatal or nonfatal stroke.

Results The active-treatment group (1933 patients) and the placebo group (1912 patients) were well matched (mean age, 83.6 years; mean blood pressure while sitting, 173.0/90.8 mm Hg); 11.8% had a history of cardiovascular disease. Median follow-up was 1.8 years. At 2 years, the mean blood pressure while sitting was 15.0/6.1 mm Hg lower in the active-treatment group than in the placebo group. In an intention-to-treat analysis, active treatment was associated with a 30% reduction in the rate of fatal or nonfatal stroke (95% confidence interval [CI], –1 to 51; P=0.06), a 39% reduction in the rate of death from stroke (95% CI, 1 to 62; P=0.05), a 21% reduction in the rate of death from any cause (95% CI, 4 to 35; P=0.02), a 23% reduction in the rate of death from cardiovascular causes (95% CI, –1 to 40; P=0.06), and a 64% reduction in the rate of heart failure (95% CI, 42 to 78; P<0.001). Fewer serious adverse events were reported in the active-treatment group (358, vs. 448 in the placebo group; P=0.001).

Conclusions The results provide evidence that antihypertensive treatment with indapamide (sustained release), with or without perindopril, in persons 80 years of age or older is beneficial. (ClinicalTrials.gov number, NCT00122811 [ClinicalTrials.gov] .)