小剂量氢氯噻嗪联合尼群地平治疗农村地区高血压疗效分析

目的 评价小剂量氢氯噻嗪联合尼群地平治疗农村地区高血压的疗效.方法 2006年6月,按整群随机抽样方法,在辽宁省阜新县选取原发高血压患者5292例,分为健康教育组(对照组)及药物干预组(干预组);干预组以阶梯式加药方式给予氢氯噻嗪、尼群地平及卡托普利,观察药物的降压效果及对脑卒中发病的影响.结果 5292例高血压患者平均随访15个月.至随访结束共有308例失访(失访率为5.8%).进入队列的4984例完成各种指标检测,其中干预组2530例,对照组2454例.经过健康教育及药物干预后,干预组平均血压下降16.1/9.4 mm Hg(1 mm Hg=0.133kPa),对照组平均血压下降6.7/3.5 mmHg.干预组的血压控制率高于对照组(33.1%比15.1%,P＜0.001).药物干预后,干预组比对照组非致死性脑卒中发病风险减少57.3%,总脑卒中发病风险减少59.4%.差异有统计学意义(P＜0.05).至随访结束,两组人群的严重低血钾发生率及新发糖尿病发生率差异无统计学意义.结论 以噻嗪利尿剂为基础的低成本降压方案,降压效果好,安全性高,显示良好的价效比,适合在中国农村地区推广.

Analysis of therapeutic effects of rural patients with hypertension by combination administration of low dosage of hydrochlorothiazide and nitrendipine

Objective To evaluate the therapeutic effects of combination administration of hydrochlorothiazide and nitrendipine at low dosage in the treatment of rural hypertension patients.Methods By the method of cluster random sampling,5292 primary hypertension patients from Fuxin,Liaoning Province were divided into health education group(control group)and drug intervention group in June 2006.The drug intervention group were treated with hydrochlorothiazide,nitrendipine and captopril by stepwise approach and we observe the antihypertensive effect of drug and the effect on the onset of stroke.Results The average follow-up time was 15 months.At last,308 patients were lost to follow-up(the lost follow-up rate was 5.8 percent).The 4984 in cohort,including 2530 of intervention group and 2454 of control group,had examination of all indicators.Through health education and drug intervention,the average blood pressure in drug intervention group decreased by 16.1/9.4 mm Hg(1 mm Hg=0.133 kPa)while the average blood pressure in control group decreased by 6.7/3.5 mm Hg.The control rate of blood pressure in drug intervention group was higher than control group(33.1%vs.15.1%,P＜0.001).Through drug intervention,the morbidity risk of nonfatal stroke in drug intervention group decreased by 57.3%compared to control group,the total morbidity risk of stroke decreased by 59.4%.The results had significant statistical difference.And,the morbidity of severe hypopotassaemia(K~+＜3.0 mmol/L)and diabetes mellitus had no significant statistical diffefence between two groups.Conclusions The low-cost antihypertensive program based on thiazide had good antihypertensive effect,high safety and good cost-effect ratio.The program could be used in rural areas of China.