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目的:探讨农村地区4种抗高血压药物4周治疗降压疗效及不良反应的差异。方法:以社区为基础的随机、双盲临床试验。在河南信阳平桥区入选40～75岁未经治疗的高血压患者3408例。随机分配到阿替洛尔组(12.5～25mg/d)594例,双氢克尿噻组(12.5～25mg/d)891例,硝苯地平缓释剂组(20～40mg/d)947例,卡托普利组(25～50mg/d)976例。随访治疗4周后血压和不良反应。结果:治疗4周整体达标率收缩压44.5%,舒张压56.2%。双氢克尿噻组和硝苯地平缓释剂组男、女性收缩压和舒张压达标率均显著优于卡托普利组和阿替洛尔组(均P<0.001)。调整年龄、血糖、药物剂量、治疗前血压等因素后,收缩压降压反应在双氢克尿噻组[男(-18.7±1.2)mmHg(1mmHg=0.133kPa),女(-21.5±1.9)mmHg]和硝苯地平缓释剂组[男(-20.9±1.3)mmHg,女(-23.1±1.7)mmHg]显著优于阿替洛尔组[男(-11.2±1.5)mmHg,女(-16.6±1.0)mmHg]和卡托普利组[男(-15.7±1.1)mmHg,女(-14.9±1.6)mmHg],P<0.001。卡托普利组舒张压降压反应显著低于其他治疗组(P<0.001)。双氢克尿噻组不良反应(4.62%)显著低于阿替洛尔组(11.1%)、硝苯地平缓释剂组(8.03%)和卡托普利组(7.52%)(P<0.001)。结论:小剂量双氢克尿噻的收缩压降压反应和达标率相对较高,不良反应发生率低,价格便宜,适合我国农村高血压患者的一线治疗。
Objective: To investigate the antihypertensive effect and adverse reaction of 4 antihypertensive drugs in rural areas in 4 weeks. METHODS: A community-based randomized, double-blind clinical trial. In Henan Xinyang Pingqiao District selected 40 to 75 years of age untreated hypertension in 3408 cases. Randomly allocated to atenolol group (12.5 ~ 25mg / d) 594 cases, hydrochlorothiazide group (12.5 ~ 25mg / d) 891 cases, nifedipine sustained-release group (20 ~ 40mg / d) 947 cases , Captopril group (25 ~ 50mg / d) 976 cases. Follow-up treatment for 4 weeks after blood pressure and adverse reactions. Results: After 4 weeks of treatment, the overall compliance rate was 44.5% and diastolic pressure was 56.2%. Both systolic blood pressure and diastolic blood pressure in both hydrochlorothiazide and nifedipine groups were significantly better than those in captopril group and atenolol group (both P <0.001). After adjusting for factors such as age, blood glucose, drug dose and blood pressure before treatment, the systolic blood pressure-depressant response was significantly lower in the hydrochlorothiazide group (-18.7 ± 1.2 mmHg (-1mmHg = 0.133kPa) and -21.5 ± 1.9% mmHg] and nifedipine slow release [male (-20.9 ± 1.3) mmHg, female (-23.1 ± 1.7) mmHg] were significantly better than those in the atenolol group (-11.2 ± 1.5 mmHg, 16.6 ± 1.0 mmHg] and captopril [male (-15.7 ± 1.1) mmHg, female (-14.9 ± 1.6) mmHg], P <0.001. The antihypertensive response of captopril group was significantly lower than that of other treatment groups (P <0.001). The side effects of hydrochlorothiazide (4.62%) were significantly lower than those of atenolol (11.1%), nifedipine (8.03%) and captopril (7.52%) (P <0.001 ). CONCLUSIONS: The low-dose hydrochlorothiazide systolic blood pressure response and compliance rate is relatively high, the incidence of adverse reactions is low, cheap, suitable for first-line treatment of rural patients with hypertension in our country.