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目的研究氢氯噻嗪与螺内酯或卡托普利长期联用对高血压病患者心脑血管事件的影响。方法采用多中心双盲研究设计,选择原发性高血压病患者251例,随机分为螺内酯组(氢氯噻嗪12.5mg+螺内酯20 mg每日1次)和卡托普利组(氢氯噻嗪12.5 mg每日1次+卡托普利25 mg每日2次),共治疗5年。治疗期间每月随访1次,随访时测量血压,收集心脑血管事件的证据材料,定期进行血生化指标检测。结果最终222例患者完成试验,螺内酯组112例,卡托普利组110例。(1)治疗5年末,2组患者血压均较治疗前显著下降(P<0.01),但组间比较差异无统计学意义(P>0.05);(2)治疗5年末,2组总终点事件、脑卒中事件、心脏事件、总死亡事件发生率螺内酯组为7.1%、4.5%、2.7%、1.8%;卡托普利组为4.6%、3.6%、0.9%、0.9%。卡托普利组各事件发生率低于螺内酯组,但差异均无统计学意义(P>0.05)。(3)2组不良反应事件发生率差异无统计学意义(P>0.05)。结论氢氯噻嗪与螺内酯或卡托普利长期联用降压效果及预防心脑血管事件的作用相似。
Objective To study the long-term effects of hydrochlorothiazide and spironolactone or captopril on the cardiovascular and cerebrovascular events in patients with essential hypertension. Methods A multicenter, double-blind study was designed. 251 patients with essential hypertension were randomly divided into spironolactone (hydrochlorothiazide 12.5 mg + spironolactone 20 mg once daily) and captopril (hydrochlorothiazide 12.5 mg daily 1 Times + captopril 25 mg twice daily) for a total of 5 years. During the treatment period, the patients were followed up once a month, blood pressure was measured during follow-up, Evidence materials of cardiovascular and cerebrovascular events were collected, and blood biochemical indexes were detected regularly. Results The final 222 patients completed the test, 112 cases of spironolactone group, captopril group of 110 cases. (1) At the end of 5 years of treatment, the blood pressure of the two groups decreased significantly (P <0.01), but there was no significant difference between the two groups (P> 0.05); (2) The incidence of stroke, cardiac events and total deaths were 7.1%, 4.5%, 2.7% and 1.8% in the spironolactone group and 4.6%, 3.6%, 0.9% and 0.9% in the captopril group. Captopril group events were lower than the spironolactone group, but the difference was not statistically significant (P> 0.05). (3) There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusion Hydrochlorothiazide and spironolactone or captopril long-term use of antihypertensive effect and prevention of cardiovascular and cerebrovascular events similar.