偏高的血压毫无疑问需要治疗－VA研究结果

来源: 虎嗅蔷薇于 2017-12-23 10:29:50 [档案] [旧帖] [给我悄悄话] 本文已被阅读：次 (2355 bytes)

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对于ACA／AHA新版血压指南的争议，焦点在140vs130

鉴于看到有不少网友实例，血压早超过140不少，生活方式改变降压效果微弱时仍然不愿药物治疗。。。我接着发这篇研究给大家参考。这是60年代的一个里程碑式对照研究，结果非常清晰，毫无模棱两可的灰色地域：偏高与严重的高血压毫无疑问需要治疗。

The Veterans Administration (VA) cooperative study on antihypertensive agents was a major milestone achieved in medicine. This was the first adequately powered placebo-controlled, RCT of antihypertensive therapy (15). The phase 1 of the study examined active treatment (hydrochlorothiazide, reserpine, and hydralazine) vs. placebo in 143 veterans with severe hypertension (diastolic blood pressure 115–129 mmHg) and achieved an average fall of blood pressure by 43/30 mmHg in the treated group. The recruitment started in 1964 and average follow-up was about 1.5 years. The results of the study showed clear morbidity and mortality benefit, most remarkably in reduction in progression to accelerated/malignant hypertension in the treatment group.

Study summary:

Total patients – 70 in each group
BP achieved – 91.6 vs. 119.7
Events-
– Death: 4 in control, 0 in treatment group
– Morbid Events: 27 in control, 2 in Rx group
Morbid events included progression to malignant hypertension as evidenced by fundal hemorrhage, CVA, MI, heart failure, and dissecting aneurysm.

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高血压是一种沉默杀手，可以没有不适症状。血压真的高了，不治疗后果可能很严重(比如上面的黑斜段落所列)，需要认真对待，不要以侥幸心理忽略。至于多高为偏高需要治疗，请和医生咨询。指南是针对全民大人口的，医生治疗病人是都是针对一个一个的个体来治的。西医里，只要你以生活方式改变真能取得确实而明显的疗效，没有医生会叫你去吃药。