Impact of amlodipine-based therapy among older and younger patients in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA)
Impact of amlodipine-based therapy among older and younger patients in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA)
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DOI：
10.1097/hjh.0b013e328342c845
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发表时间：
2011-03-01
影响因子：
4.9
通讯作者：
Caulfield, Mark J.
中科院分区：
文献类型：
--
作者：
Collier, David J.;Poulter, Neil R.;Caulfield, Mark J.
目的老年患者心血管疾病的发生率高于年轻患者，但研究表明，老年患者抗高血压治疗的相对风险降低低于年轻患者。盎格鲁-斯堪的纳维亚心脏结局试验-降压试验(ASCOT-BPLA)在老年(65岁)和年轻(65岁)患者中评价了氨氯地平和阿替洛尔降压方案的有效性和安全性。方法在ASCOT-BPLA19 257名患者(8137名年龄=65岁和11 020&65岁)随机分配接受氨氯地平或阿替洛尔降压治疗。主要终点(非致命性心肌梗死和致命性冠心病)和7个次要终点与最初的试验设计一致。结果所有被评估的心血管终点都支持基于氨氯地平的方案，在16个年龄分层的终点中有7个明显如此。与以阿替洛尔为基础的方案相比，以氨氯地平为基础的方案将老年患者心血管事件的相对风险降低了17%，而在年轻患者中降低了15%(P<；0.01)。总体而言，老年患者比年轻患者[n=1625(20%)]发生更多的心血管事件[n=1625(20%)]比年轻患者[n=1339(12%)]。由于严重不良事件的中断在两个年龄组中都很低，在使用氨氯地平的患者中比使用阿替洛尔的患者减少心血管事件的相对风险分别为0.6%和1.1%，在使用阿替洛尔的患者中分别为0.4%和0.8%。结论在老年和年轻患者中，基于氨氯地平的方案比基于阿替洛尔的方案更有效地降低心血管事件的相对风险。然而，由于老年患者的事件发生率较高，与年轻患者相比，老年患者的绝对益处更大。J Hyperten 29：583-591(C)2011 Wolters Kluwer Health垂直酒吧Lippincott Williams&Wilkins。
Objectives Older patients experience higher rates of cardiovascular disease than younger patients, but studies have suggested that relative risk reductions due to antihypertensive therapy are lower in older than younger patients. The Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) allowed an evaluation of the efficacy and safety of an amlodipine versus an atenolol-based antihypertensive regimen among older (>= 65 years) and younger (< 65 years) patients.Methods In ASCOT-BPLA 19 257 patients (8137 aged >= 65 years and 11 020 < 65 years) were randomly assigned to receive amlodipine or atenolol-based antihypertensive therapy. The primary endpoint (nonfatal myocardial infarction and fatal coronary heart disease) and seven secondary endpoints were consistent with the original trial design.Results All cardiovascular endpoints evaluated favoured the amlodipine-based regimen, significantly so in seven of the 16 age-stratified endpoints. Compared with the atenolol-based regimen, the amlodipine-based regimen reduced the relative risk of cardiovascular events by 17% in older and 15% in younger patients (P < 0.01). Overall, older patients experienced more cardiovascular events [n = 1625 (20%)] than younger patients [n = 1339 (12%)].Discontinuations due to serious adverse events were low in both age groups and less frequent in the amlodipine-based versus atenolol-based regimen: 0.6 versus 1.1% among older patients and 0.4 versus 0.8% among younger patients.Conclusions The amlodipine-based regimen reduced the relative risk of cardiovascular events more effectively than the atenolol-based regimen in both older and younger patients. However, because event rates were higher among older patients, the absolute benefits were greater for older compared with younger patients. J Hypertens 29:583-591 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.