摘要

CONTEXT:In the Systolic Hypertension in the Elderly Program (SHEP) trial, conducted between 1985 and 1990, antihypertensive therapy with chlorthalidone-based stepped-care therapy resulted in a lower rate of cardiovascular events than placebo but effects on mortality were not significant.
OBJECTIVE:To study the gain in life expectancy of participants randomized to active therapy at the 22-year follow-up.
DESIGN, SETTING, AND PARTICIPANTS:A National Death Index ascertainment of death in the long-term follow-up of a randomized, placebo-controlled, clinical trial (SHEP) of patients aged 60 years or older with isolated systolic hypertension. Recruitment was between March 1, 1985, and January 15, 1988. After the end of a 4.5-year randomized phase of the SHEP trial, all participants were advised to receive active therapy. The time interval between the beginning of recruitment and the ascertainment of death by National Death Index (December 31, 2006) was approximately 22 years (21 years 10 months).
MAIN OUTCOME MEASURES:Cardiovascular death and all-cause mortality.
RESULTS:At the 22-year follow-up, life expectancy gain, expressed as the area between active (n = 2365) and placebo (n = 2371) survival curves, was 105 days (95% CI, -39 to 242; P = .07) for all-cause mortality and 158 days (95% CI, 36-287; P = .009) for cardiovascular death. Each month of active treatment was therefore associated with approximately 1 day extension in life expectancy. The active treatment group had higher survival free from cardiovascular death vs the placebo group (hazard ratio [HR], 0.89; 95% CI, 0.80-0.99; P = .03) but similar survival for all-cause mortality (HR, 0.97; 95% CI, 0.90-1.04; P = .42). There were 1416 deaths (59.9%) in the active treatment group and 1435 deaths (60.5%) in the placebo group (log-rank P = .38, Wilcoxon P = .24). Cardiovascular death was lower in the active treatment group (669 deaths [28.3%]) vs the placebo group (735 deaths [31.0%]; log-rank P = .03, Wilcoxon P = .02). Time to 70th percentile survival was 0.56 years (95% CI, -0.14 to 1.23) longer in the active treatment group vs the placebo group (11.53 vs 10.98 years; P = .03) for all-cause mortality and 1.41 years (95% CI, 0.34-2.61; 17.81 vs 16.39 years; P = .01) for survival free from cardiovascular death.
CONCLUSION:In the SHEP trial, treatment of isolated systolic hypertension with chlorthalidone stepped-care therapy for 4.5 years was associated with longer life expectancy at 22 years of follow-up.

译文

背景: 在 1985年至 1990 间进行的老年人收缩期高血压项目 (SHEP) 试验中, 与安慰剂相比,以氯沙利酮为基础的分级治疗的降压治疗导致心血管事件的发生率较低,但对死亡率的影响并不显著。
目的: 研究在 22 年随访中随机接受积极治疗的参与者的预期寿命增加。
设计、设置和参与者: 一项随机、安慰剂对照、临床试验 (SHEP) 的长期随访中确定死亡的国家死亡指数 60 岁或以上的单纯收缩期高血压患者中。招募时间为 1985年3月1日至 1988年1月15日。在 SHEP 试验的 4.5 随机阶段结束后,建议所有参与者接受积极治疗。从开始招募到通过国家死亡指数 (2006年12月31日) 确定死亡的时间间隔大约是 22 年 (21 年 10 个月)。
主要观察指标: 心血管死亡和全因死亡率。
结果: 在 22 年的随访中,预期寿命增加,表现为活跃 (n = 2365) 和安慰剂 (n = 2371) 生存曲线之间的面积, 是 105 天 (95% CI,-39 到 242; P =。 07) 为全因死亡率和 158 天 (95% CI,36-287;P =.009) 用于心血管死亡。因此,每个月的积极治疗与大约 1 天的预期寿命延长有关。与安慰剂组相比,积极治疗组的无心血管死亡存活率更高 (风险比 [HR],0.89; 95% CI,0.80-0.99; P =。 03),但全因死亡率的存活率相似 (HR,0.97; 95% CI,0.90-1.04; P =。 42)。在积极治疗组中有 1416 例死亡 (59.9%),在安慰剂组中有 1435 例死亡 (60.5%) (log-rank P =.38,Wilcoxon P =.24)。积极治疗组 (669 例死亡 [28.3%]) 心血管死亡低于安慰剂组 (735 例死亡 [31.0%]; log-rank P =。 03,Wilcoxon P =。 02)。积极治疗组与安慰剂组相比,0.56 百分位生存期延长了 95% 年 (0.14 CI,-1.23 至 11.53) (10.98 对年; P =。 03) 对于全因死亡率和 1.41 年 (95% CI,0.34-2.61; 17.81 vs 16.39 年; P =。 01)免于心血管死亡。
结论: 在 SHEP 试验中,在 22 年的随访中,使用氯沙利酮强化治疗单纯收缩期高血压 4.5 年与更长的预期寿命相关。

Chlorthalidone

肾内泌尿 利尿排钠 药物
概述  :  

疾病概述氯肽酮(Chlorthalidone)是利尿药,为白色或类白色结晶性粉末,无臭,无味。作用同氢氯噻嗪,但作用较持久。除利尿排钠作用外,可能还有肾外作用机制参与降压,可能是增加胃肠道对Na+的排泄。用于治疗各种原因所引起的水肿及高血压。 药理作用除利尿排钠作用外,可能还有肾外作用机制参与降压,可能是增加胃肠道对Na+的排泄。对肾血流动力学和肾小球滤过功能的影响:由于氯酞酮使肾小管对水、Na+重吸收减少,肾小管内压力升高,以及流经远曲小管的水和Na+增多,刺激致密斑通过管-球反射,

Chlorthalidone   /klɔ:'θælidəun/

释    义   n. [药] 氯噻酮(利尿降压药)

例    句   Chlorthalidone also reduced the incidence of new-onset HFPEF compared with lisinopril. 与赖诺普利相比,氯噻酮能减少HFPEF发生率。

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