Diuretic versus α-blocker as first-step antihypertensive therapy -: Final results from the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)
Diuretic versus α-blocker as first-step antihypertensive therapy -: Final results from the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)
复制标题
DOI：
10.1161/01.hyp.0000086521.95630.5a
复制
发表时间：
2003-09-01
期刊：
影响因子：
8.3
通讯作者：
Alderman, MH
中科院分区：
文献类型：
--
作者：
Alderman, MH
抗高血压和降脂治疗预防心脏病试验 (ALLHAT) 是一项随机、双盲、主动对照临床试验，旨在确定新型抗高血压药物（包括多沙唑嗪（一种 α 阻滞剂））与氯噻酮（一种利尿剂）在冠心病 (CHD) 和其他心血管疾病 (CVD) 事件方面对冠心病 (CHD) 高风险高血压患者是否有所不同。 2000 年 2 月，多沙唑嗪治疗组停止，并报告了截至 1999 年 12 月的研究结果。该报告还包括 9232 个参与者年和 939 个 CVD 事件。在 623 个临床中心，患有高血压和至少 1 个其他 CHD 危险因素的患者（年龄大于或等于 55 岁）被随机分配接受氯噻酮或多沙唑嗪治疗。主要结局指标是致命性 CHD 或非致命性心肌梗死 (MI) 的合并发生率，按治疗意向进行分析；预先指定的次要结局指标包括全因死亡率、中风、合并冠心病（致死性冠心病、非致死性心肌梗死、住院心绞痛和冠状动脉血运重建）和合并心血管疾病（合并冠心病、中风、院外治疗的心绞痛、心力衰竭和外周动脉疾病）。平均随访时间为 3.2 年。两组之间的主要结局没有差异（相对风险 [RR]，1.02；95% 置信区间 [CI]，0.92 至 1.15）。全因死亡率也没有差异（RR，1.03；95% CI，0.94 至 1.13）。然而，与氯噻酮组相比，多沙唑嗪组的卒中风险（RR，1.26；95％CI，1.10至1.46）和合并CVD（RR，1.20；95％CI，1.13至1.27）的风险更高。这些发现证实了以利尿剂为基础的抗高血压治疗在预防 CVD 方面优于以 α 受体阻滞剂为基础的治疗。
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind, active, controlled clinical trial conducted to determine whether newer antihypertensive agents, including doxazosin, an alpha-blocker, differ from chlorthalidone, a diuretic, with respect to coronary heart disease (CHD) and other cardiovascular disease (CVD) events in hypertensive patients at high risk of CHD. In February 2000, the doxazosin treatment arm was discontinued, and findings through December 1999 were reported. This report includes an additional 9232 participant-years and 939 CVD events. At 623 clinical centers, patients ( aged greater than or equal to 55 years) with hypertension and at least 1 other CHD risk factor were randomly assigned to either chlorthalidone or doxazosin. The primary outcome measure was the combined occurrence of fatal CHD or nonfatal myocardial infarction (MI), analyzed by intent to treat; prespecified secondary outcome measures included all-cause mortality, stroke, combined CHD ( fatal CHD, nonfatal MI, hospitalized angina, and coronary revascularization), and combined CVD ( combined CHD, stroke, angina treated outside the hospital, heart failure, and peripheral arterial disease). Mean follow-up was 3.2 years. There was no difference in primary outcome between the arms ( relative risk [RR], 1.02; 95% confidence interval [CI], 0.92 to 1.15). All-cause mortality also did not differ ( RR, 1.03; 95% CI, 0.94 to 1.13). However, the doxazosin arm compared with the chlorthalidone arm had a higher risk of stroke ( RR, 1.26; 95% CI, 1.10 to 1.46) and combined CVD ( RR 1.20; 95% CI, 1.13 to 1.27). These findings confirm the superiority of diuretic-based over alpha-blocker - based antihypertensive treatment for the prevention of CVD.