主要心血管事件的高血压患者随机分配到doxazosin vs氯噻酮:降压和降脂治疗预防心脏病发作试验(ALLHAT)。ALLHAT合作研究小组。必威国际app

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主要心血管事件的高血压患者随机分配到doxazosin vs氯噻酮:降压和降脂治疗预防心脏病发作试验(ALLHAT)。ALLHAT合作研究小组。必威国际app

《美国医学协会杂志》上。2000年4月19日,283 (15):1967 - 75。

PubMed ID

10789664 (在PubMed

]

文摘

背景:高血压与发病率和死亡率的风险大大增加。只有利尿剂和β受体阻断剂可以降低这种风险的长期临床试验。新降压药是否降低心血管疾病(CVD)的发生率是未知的。目的:比较doxazosin的影响,一个治疗组,氯噻酮,一种利尿剂,在高血压患者的心血管疾病发生率的研究4种抗高血压药物:氯噻酮、doxazosin,氨氯地平、赖诺普利。设计:随机、双盲、active-controlled临床试验,降压和降脂治疗预防心脏病发作试验,1994年2月启动。2000年1月,经过一个过渡分析,一个独立的数据审查委员会建议中止doxazosin基于比较氯噻酮治疗手臂。因此,本文提供的结果数据反映随访到1999年12月。设置:共有625个中心在美国和加拿大。参与者:共有24335名患者(年龄> = 55年)与高血压和至少1其他冠心病(CHD)的危险因素接受doxazosin或氯噻酮。干预:参与者被随机分配接受氯噻酮、12.5 - 25 mg / d (n = 15268),或doxazosin, 2 - 8 mg / d (n = 9067),计划4到8年的随访。 MAIN OUTCOME MEASURES: The primary outcome measure was fatal CHD or nonfatal myocardial infarction (MI), analyzed by intent to treat; secondary outcome measures included all-cause mortality, stroke, and combined CVD (CHD death, nonfatal MI, stroke, angina, coronary revascularization, congestive heart failure [CHF], and peripheral arterial disease); compared by the chlorthalidone group vs the doxazosin group. RESULTS: Median follow-up was 3.3 years. A total of 365 patients in the doxazosin group and 608 in the chlorthalidone group had fatal CHD or nonfatal MI, with no difference in risk between the groups (relative risk [RR], 1.03; 95% confidence interval [CI], 0.90-1.17; P=.71). Total mortality did not differ between the doxazosin and chlorthalidone arms (4-year rates, 9.62% and 9.08%, respectively; RR, 1.03; 95% CI, 0.90-1.15; P=.56.) The doxazosin arm, compared with the chlorthalidone arm, had a higher risk of stroke (RR, 1.19; 95% CI, 1.01-1.40; P=.04) and combined CVD (4-year rates, 25.45% vs 21.76%; RR, 1.25; 95% CI, 1.17-1.33; P<.001). Considered separately, CHF risk was doubled (4-year rates, 8.13% vs 4.45%; RR, 2.04; 95% CI, 1.79-2.32; P<.001); RRs for angina, coronary revascularization, and peripheral arterial disease were 1.16 (P<.001), 1.15 (P=.05), and 1.07 (P=.50), respectively. CONCLUSION: Our data indicate that compared with doxazosin, chlorthalidone yields essentially equal risk of CHD death/nonfatal MI but significantly reduces the risk of combined CVD events, particularly CHF, in high-risk hypertensive patients.

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药物

氯噻酮