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目的研究长期降压治疗对脑血管病患者脑卒中再发事件的影响。方法入选标准:有脑血管病病史;患者能到门诊随访;知情同意;无研究药物治疗的明确适应症及禁忌症。用大样本随机对照试验方法,患者被随机分为血管紧张素转换酶抑制剂(ACEI)+吲哒帕胺治疗组和相匹配的安慰剂对照组,双盲治疗4年,开盲后开放治疗2年,共随访6年。研究主要终点是脑卒中。终点委员会专家独立评估可疑脑卒中等事件。结果患者1399例进入随机双盲研究,治疗组702例,对照组697例。患者基线特征治疗组与对照组相似,平均年龄为64岁;男性占70%;有脑出血史为18%;脑梗死史为76%;一过性脑缺血发作(TIA)史为9%;冠心病史为21%;糖尿病为11%。两组平均血压分别为(145.9±20.4)/(87.1±11.1)mmHg与(145.6±20.4)/(87.8±11.6)mmHg。双盲治疗4年治疗组较对照组血压净下降12.5/5.3mmHg,开放治疗2年净下降9.2/4.7mmHg,随访6年血压平均净下降10.5/5.0mmHg。双盲治疗4年治疗组脑卒中发生(9.5%)较对照组(20.2%)危险下降53%(P<0.01);开放2年脑卒中危险下降25%(P=0.19);随访6年脑卒中危险下降46%(P<0.01)。结论长期降压治疗对脑血管病患者是有益的,可减少脑卒中再发的危险。
Objective To study the effect of long-term antihypertensive therapy on recurrent stroke in patients with cerebrovascular disease. Methods Inclusion criteria: a history of cerebrovascular disease; patients were able to go to the clinic for follow-up; informed consent; no clear indications and contraindications to study drug therapy. In a large randomized controlled trial, patients were randomized to receive either an ACEI plus indapamide treatment or a placebo-matched control, followed by a double-blind treatment of 4 years and an open-ended treatment 2 years, a total of 6 years follow-up The primary endpoint of the study was stroke. End-point board experts independently assess suspicious stroke and other events. Results A total of 1399 patients were enrolled in the randomized, double-blind study, 702 in the treatment group and 697 in the control group. The baseline characteristics of patients in the treatment group were similar to those in the control group, with an average age of 64 years; 70% of men; 18% of patients with cerebral hemorrhage; 76% of cerebral infarctions; 9% of patients with transient ischemic attack (TIA) ; Coronary heart disease history was 21%; diabetes was 11%. Mean blood pressure in the two groups were (145.9 ± 20.4) / (87.1 ± 11.1) mmHg and (145.6 ± 20.4) / (87.8 ± 11.6) mmHg, respectively. The double-blind treatment 4-year treatment group had a net decrease of 12.5 / 5.3mmHg compared with the control group, a net decrease of 9.2 / 4.7mmHg after 2 years of open treatment and an average net decrease of 10.5 / 5.0mmHg after 6 years of follow-up. The risk of stroke in the double-blind treatment 4-year treatment group (9.5%) was 53% lower than that in the control group (20.2%) (P 0. 01); stroke risk decreased 25% (P 0.19) The risk of stroke decreased 46% (P <0.01). Conclusions Long-term antihypertensive therapy is beneficial for patients with cerebrovascular disease and reduces the risk of recurrent stroke.