农村地区4种降压药物短期降压疗效与不良反应的对比

Comparison of efficacy and adverse events among four antihypertensive drugs in rural hypertensive patients

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 compare the efficacy and tolerability of 4 antihypertensive drugs after 4-week＇s monotherapy in untreated rural hypertensive patients in China. Method： A total of 3 408 untreated patients （66% women） aged 40 to 75 years were enrolled from 7 communities in XinYang County from March to May in 2005. Patients were randomized to 1 of 4 treatments-atenolol （12.5-25 mg/d） group of 594, or hydrochlorothiazide （12.5-25 mg/d） of 891, or nifedipine sustained release （20-40 mg/d） of 947, or captopril （25-50 mg/d） of 976, respectively. After 4 weeks treatment, the mean reduction in blood pressure and adverse events were assessed. Resuit：On week 4, the control goal rates were 44.5% for systolic and 56.2% for diastolic pressure as a whole. The control goal rates for systolic blood pressure were significantly higher in hydrochlorothiazide and nifedipine SR than in atenolol and captopril groups in both male and female patients （both P〈0. 001）. After adjustment for age, blood glucose, drug doses and pretreatment blood pressure, the mean reductions in systolic pressure were significantly greater in hydrochlorothiazide （[ 18.7 ±1.2] mmHg） and Nifedipine （[20.9±1.3 ] mmHg） than atenolol （[11.2±1.5]mmHg） and captopril （[15.7± 1.1]mmHg） （P〈0. 001） in male patients and similar results were observed in female patients. The mean reduction in diastolic pressure was significantly lower in captopril group both in male and female patients （P〈0. 001）. Total adverse events were significantly lower in hydrochlorothiazide （4.62%） than atenolol （11.1%）, nifedipine （8.03%）, and captopril （7.52%） （P〈0. 001）. Conclusion：Our results support that low dose hydrochlorothiazide is suitable as the first line antihypertensive treatment in developing countries due to its significantly higher efficacy, better tolerability, and lower cost.