用于轻度高血压的药物治疗
Dominic Wang1, James M Wright2, Stephen P Adams2
1Department of Medicine, University of British Columbia, Vancouver, Canada.
The Cochrane database of systematic reviews
|September 24, 2025
概括
开始治疗轻度高血压的抗高血压药物治疗对死亡率或心血管事件没有明显的益处. 虽然中风风险可能会降低,但由于不良影响 (WDAE) 的戒断会增加,总体而言,证据的确定性很低.
科学领域:
- 心脏病学和高血压研究研究
- 基于证据的医学和系统性审查.
- 药物治疗的有效性和安全性
背景情况:
- 没有心血管疾病的轻度高血压 (静脉血压140-159 mmHg或静脉血压90-99 mmHg) 对药物治疗的启动具有不确定的前景.
- 之前的审查表明,在这个人群中,抗高血压治疗的死亡率,心血管事件或不良反应没有显著差异.
- 相互矛盾的研究结果需要对启动抗高血压药物治疗以预防轻度高血压的初级预防进行更新的评估.
研究的目的:
- 重新评估在未经治疗的轻度高血压的成年人中启动抗高血压药物治疗的疗效和风险,而不是安慰剂或不治疗.
- 主要目标:评估对所有原因死亡率和心血管总事件 (中风,心肌梗塞,心力衰竭) 的影响.
- 二级目标:评估对中风发病率,冠心病和因不良反应而导致的戒断的影响.
主要方法:
- 更新的系统审查,包括至少为期一年的随机对照试验 (RCT).
- 搜索了多个数据库 (Cochrane高血压,CENTRAL,MEDLINE,Embase,ClinicalTrials.gov,WHO ICTRP) 截至2024年6月.
- 使用Cochrane的RoB 1工具评估偏差风险和使用GRADE的证据确定性;使用Mantle-Haenszel固定效应模型合成数据.
主要成果:
- 五项试验 (9,124名参与者) 将抗高血压药与安慰剂/不接受治疗进行了比较.
- 抗高血压药物几乎没有减少全因死亡率 (低确定性),总心血管事件 (低确定性) 或冠心病 (低确定性).
- 观察到潜在的中风风险降低 (低确定性),以及由于不良影响 (WDAE) (低确定性) 而导致戒断的显著增加.
结论:
- 启动抗高血压单一治疗或缓解轻度,未经治疗的高血压而没有先前存在的心血管疾病的逐步治疗可能不会对死亡率或主要心血管事件提供显著的益处.
- 可能会降低中风风险,但这与导致治疗中止的不良事件显著增加相抵消.
- 这些结果的总体证据确定性很低,这凸显了需要谨慎解释和进一步研究这一领域的需要.
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