老年妇女心血管预后与降压药治疗之间的关系

作     者：Wassertheil-Smoller S. Psaty B. Greenland P. 王亭忠 

作者机构：Dept. of Epidemiol. and Pop. Health Albert Einstein College of Medicine Belfer Building Morris Park Ave Bronx NY 10461 United States Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第5期

页      面：20-21页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：降压药治疗 绝经后高血压 钙离子拮抗剂 β受体阻断剂 药物联合治疗 降压药物 利尿剂治疗 药物联合应用 队列研究 脑卒中发病率 

摘      要：Context: Diuretic-based therapy is at least as effective as newer classes of agents for hypertension. However, many patients with hypertension require treatment with more than 1 drug class to achieve blood pressure control. The relative benefits or risks of 2-drug-class combinations are not well known. Objective: To prospectively evaluate if there are differences in cardiovascular mortality among postmenopausal women with hypertension but no history of cardiovascular disease(CVD)treated with different classes of antihypertensive agents, singly or in combination. Design, Setting, and Participants: Women with hypertension enrolled in the Womens Health Initiative Observational Study, a longitudinal multicenter cohort study of 93 676 women aged 50 to 79 years at baseline(1994-1998), assessed for a mean of 5.9 years. Main Outcome Measures: Relationship between baseline use of ACE inhibitors, β-blockers, calcium channel blockers, or diuretics, or a combination of these, and incidence of coronary heart disease, stroke, and CVD mortality. Results: Among 30219 women with hypertension but no history of CVD, 11 294(57%)were receiving monotherapy with an ACE inhibitor, β-blocker, calcium channel blocker, or diuretic, and 4493(23%)were treated at baseline with a combination of diuretic plus either ACE inhibitor, β-blocker, or calcium channel blocker or ACE inhibitor plus calcium channel blocker. Monotherapy with calcium channel blockers vs diuretics was associated with greater risk of CVD death(hazard ratio, 1.55; 95%confidence interval, 1.02-2.35), controlling for multiple covariates. Women treated with a diuretic plus a calcium channel blocker had an 85%greater risk of CVD death vs those treated with a diuretic plus a β-blocker, after adjustment for age, race, smoking, high cholesterol levels requiring medication, body mass index, physical activity, use of hormone therapy, and diabetes. After exclusion of women with diabetes the hazard ratio was 2.16(95%confidence interval, 1