Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial
Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial
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DOI：
10.1161/01.hyp.0000231662.77359.de
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发表时间：
2006-09-01
期刊：
影响因子：
8.3
通讯作者：
Wright, Jackson T.
中科院分区：
文献类型：
--
作者：
Leenen, Frans H. H.;Nwachuku, Chuke E.;Wright, Jackson T.
预防心脏病发作的降压和降脂治疗试验（ALLHAT）提供了一个独特的机会，可以比较血管紧张素转换酶抑制剂和钙通道阻滞剂启动的治疗在老年高血压患者中的长期相对安全性和有效性。患者被随机分配至赖诺普利组（n=9048）或赖诺普利组（n=9054）。主要结局是按意向治疗分析的致死性冠心病或非致死性心肌梗死，次要结局包括全因死亡率、卒中、合并心血管疾病（CVD）、终末期肾病（ESRD）、癌症和消化道出血。平均随访4.9年。非黑人的血压控制相似，但黑人则不然。治疗组之间的主要结局、全因死亡率、ESRD或癌症无显著差异。赖诺普利组黑人（RR=1.51，95%CI 1.22 - 1.86）卒中发生率较高，但非黑人（RR=1.07，95%CI 0.89 - 1.28）和女性（RR=1.45，95%CI 1.17 - 1.79）卒中发生率不高，但男性（RR=1.10，95%CI 0.92 - 1.31）卒中发生率不高。由于卒中、外周动脉疾病和心绞痛的发生率较高，联合CVD的发生率较高（RR=1.06，95% CI 1.00 - 1.12），赖诺普利组心力衰竭的发生率较低（RR=0.87，95% CI 0.78 - 0.96）部分抵消了这一点。赖诺普利组胃肠道出血和血管性水肿发生率较高。有和无基线冠心病的患者显示出相似的结局模式。我们的结论是，在高血压患者中，冠状动脉事件的风险是相似的，但中风，合并心血管疾病，胃肠道出血，血管性水肿是较高的，心力衰竭是较低的赖诺普利为基础的治疗相比，氨氯地平为基础的治疗。这些差异中的一些，但不是全部，可能是由于赖诺普利组血压控制效果较差。
The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease ( ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm.