实用心电学杂志
實用心電學雜誌
실용심전학잡지
JOURNAL OF PRACTICAL ELECTROCARDIOLOGY JS
2009年
3期
183-185
,共3页
尤忠一%陆德澄%解金兴%任国庆
尤忠一%陸德澄%解金興%任國慶
우충일%륙덕징%해금흥%임국경
高血压前瞻性研究%心脑血管事件%非洛地平缓释片%氢氯噻嗪
高血壓前瞻性研究%心腦血管事件%非洛地平緩釋片%氫氯噻嗪
고혈압전첨성연구%심뇌혈관사건%비락지평완석편%경록새진
Hypertension prospective study Felodipine Cardiovascalar events Hydrochlorthiazide
目的 5年随访观察非洛地平缓释片及氢氯噻嗪双盲对照对高血压疗效及心脑血管事件发生.方法 按中国医科院阜外医院Fever研究规划,严格选择50~70岁的高血压者,经3个月用安慰剂观察期后血压在160~180/90~100mmHg之间.排除半年内心肌梗死、脑卒中、肿瘤等严重疾病.入选者按多中心双盲用非洛地平缓释片2.5~5mg/d或氢氯噻嗪12.5~25mg/d经5年随访.每例平均随访40次左右,治疗前后测坐立位血压、心率、空腹血糖、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、肌肝、尿酸、血清钾、心电图等.记录不稳定心绞痛、心肌梗死、脑卒中、死亡的发生.结果 200例中死亡6例,失访14例,随访率达93%.其余180例开盲后分为非洛地平缓释片组(T组)94例,氢氯噻嗪对照组(C组)86例.两组年龄、性别、体重指数(BMI)、基础收缩压、舒张压组间比较P>0.05有可比性.治疗前T组收缩压160.30±7.99mmHg、舒张压94.49±2.70 mm-Hg,治疗后降到133.54±8.32 mmHg及82.35±5.06mmHg.自身前后对照P<0.01,两组间P>0.05.TC、TG,T组治疗前5.46±0.81 mmol/L、2.10±0.89 mmol/L,治疗后降到5.07±1.07 mmol/L、1.75±0.59 mmol/L,前后和组间P均<0.01.HDL-C治疗前1.16±0.19 mmol/L,治疗后升高到1.20±0.21mmol/L,前后比P均<0.01,组间比P<0.01,差异显著.200例中发生心脑血管事件11例,T组4例,占4.26%;C组7例,占8.14%,肿瘤1例.T组比C组减少心脑血管事件47.78%.C组脑卒中3例(1例脑梗塞,2例脑出血)及心肌梗死1例、不稳定心绞痛3例、肿瘤1例.T组脑出血、脑梗塞、心肌梗死、不稳定心绞痛各1例.共死亡6例(含C组肿瘤1例):其中心脑血管事件5例,T组2例,占2.13%;C组3例,占3.49%,T组比C组减少心脑血管事件死亡38.97%.结论 非洛地平缓释片及小剂量氢氯噻嗪经5年前瞻性研究,两者均有良好降压作用,T组尚有降低TC、TG及升高HDL-C;T组比C组减少心脑血管事件47.78%,减少心脑血管事件死亡38.97%,故认为T组减少心脑血管事件的发生优于C组.
目的 5年隨訪觀察非洛地平緩釋片及氫氯噻嗪雙盲對照對高血壓療效及心腦血管事件髮生.方法 按中國醫科院阜外醫院Fever研究規劃,嚴格選擇50~70歲的高血壓者,經3箇月用安慰劑觀察期後血壓在160~180/90~100mmHg之間.排除半年內心肌梗死、腦卒中、腫瘤等嚴重疾病.入選者按多中心雙盲用非洛地平緩釋片2.5~5mg/d或氫氯噻嗪12.5~25mg/d經5年隨訪.每例平均隨訪40次左右,治療前後測坐立位血壓、心率、空腹血糖、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)、肌肝、尿痠、血清鉀、心電圖等.記錄不穩定心絞痛、心肌梗死、腦卒中、死亡的髮生.結果 200例中死亡6例,失訪14例,隨訪率達93%.其餘180例開盲後分為非洛地平緩釋片組(T組)94例,氫氯噻嗪對照組(C組)86例.兩組年齡、性彆、體重指數(BMI)、基礎收縮壓、舒張壓組間比較P>0.05有可比性.治療前T組收縮壓160.30±7.99mmHg、舒張壓94.49±2.70 mm-Hg,治療後降到133.54±8.32 mmHg及82.35±5.06mmHg.自身前後對照P<0.01,兩組間P>0.05.TC、TG,T組治療前5.46±0.81 mmol/L、2.10±0.89 mmol/L,治療後降到5.07±1.07 mmol/L、1.75±0.59 mmol/L,前後和組間P均<0.01.HDL-C治療前1.16±0.19 mmol/L,治療後升高到1.20±0.21mmol/L,前後比P均<0.01,組間比P<0.01,差異顯著.200例中髮生心腦血管事件11例,T組4例,佔4.26%;C組7例,佔8.14%,腫瘤1例.T組比C組減少心腦血管事件47.78%.C組腦卒中3例(1例腦梗塞,2例腦齣血)及心肌梗死1例、不穩定心絞痛3例、腫瘤1例.T組腦齣血、腦梗塞、心肌梗死、不穩定心絞痛各1例.共死亡6例(含C組腫瘤1例):其中心腦血管事件5例,T組2例,佔2.13%;C組3例,佔3.49%,T組比C組減少心腦血管事件死亡38.97%.結論 非洛地平緩釋片及小劑量氫氯噻嗪經5年前瞻性研究,兩者均有良好降壓作用,T組尚有降低TC、TG及升高HDL-C;T組比C組減少心腦血管事件47.78%,減少心腦血管事件死亡38.97%,故認為T組減少心腦血管事件的髮生優于C組.
목적 5년수방관찰비락지평완석편급경록새진쌍맹대조대고혈압료효급심뇌혈관사건발생.방법 안중국의과원부외의원Fever연구규화,엄격선택50~70세적고혈압자,경3개월용안위제관찰기후혈압재160~180/90~100mmHg지간.배제반년내심기경사、뇌졸중、종류등엄중질병.입선자안다중심쌍맹용비락지평완석편2.5~5mg/d혹경록새진12.5~25mg/d경5년수방.매례평균수방40차좌우,치료전후측좌립위혈압、심솔、공복혈당、총담고순(TC)、감유삼지(TG)、고밀도지단백담고순(HDL-C)、기간、뇨산、혈청갑、심전도등.기록불은정심교통、심기경사、뇌졸중、사망적발생.결과 200례중사망6례,실방14례,수방솔체93%.기여180례개맹후분위비락지평완석편조(T조)94례,경록새진대조조(C조)86례.량조년령、성별、체중지수(BMI)、기출수축압、서장압조간비교P>0.05유가비성.치료전T조수축압160.30±7.99mmHg、서장압94.49±2.70 mm-Hg,치료후강도133.54±8.32 mmHg급82.35±5.06mmHg.자신전후대조P<0.01,량조간P>0.05.TC、TG,T조치료전5.46±0.81 mmol/L、2.10±0.89 mmol/L,치료후강도5.07±1.07 mmol/L、1.75±0.59 mmol/L,전후화조간P균<0.01.HDL-C치료전1.16±0.19 mmol/L,치료후승고도1.20±0.21mmol/L,전후비P균<0.01,조간비P<0.01,차이현저.200례중발생심뇌혈관사건11례,T조4례,점4.26%;C조7례,점8.14%,종류1례.T조비C조감소심뇌혈관사건47.78%.C조뇌졸중3례(1례뇌경새,2례뇌출혈)급심기경사1례、불은정심교통3례、종류1례.T조뇌출혈、뇌경새、심기경사、불은정심교통각1례.공사망6례(함C조종류1례):기중심뇌혈관사건5례,T조2례,점2.13%;C조3례,점3.49%,T조비C조감소심뇌혈관사건사망38.97%.결론 비락지평완석편급소제량경록새진경5년전첨성연구,량자균유량호강압작용,T조상유강저TC、TG급승고HDL-C;T조비C조감소심뇌혈관사건47.78%,감소심뇌혈관사건사망38.97%,고인위T조감소심뇌혈관사건적발생우우C조.
Objective To compare prospectively the efficacy and safety of Feledipine and Hydrochlorthiazide in the treatment of hypertension following up five years. Methods 180 cases with hypertension were divided into two groups randomizely and double-blindedly, T group(94 patients with Felodipine 2.5~5mg twice daily for 5 yeats) and C group(86 patients with Hydrechlorthiazide12.5~25mg twice daffy for 5 years). There was no significant difference in age,,sex,body weight (BMI) and systolic blood pressure between two groups. Before and after treatment, E. C. G, blood pressure,fasting blood glucose, serum lipids (TC、TG、HDL), renal function and serum potassium were monitored and recorded. The incidence rate of unstable cardiac angina, cardiac infarction, stroke and death were also recorded. Results In T group,there were significantly differences in the blood pressure(SBP160.30±7.99mmHg, DBP 94.49±2.70mmHg before treat-ment vs SBP133.54±8.32 mmHg, DBP 82.35±5.06mmHg after treatment P < 0.01), TC (5.46±0.81 mmol/L vs 5.07±1.07 mmol/L, P <0. 01) ,TG(2.10±0.89mmol/L vs 1.75±0.59 mmol/L, P < 0.01), and HDL-C (1.16±0. 19mmol/L vs 1.20±0.21mmol/L, P<0.01). The incidence rate of cardiovascular events was decreased 47.78% in T group compared with C group, and the mortality rate was decreased 38.97%. Conclusion Feledipine showed better ef-ficacy in the treatment of high blood pressure with the benefits of decreasing the level of TC、TG, increasing the level of HDL-c, and decreasing the incidence rate of cardiovascalar e-vents.