Pharmacologic Prevention of Incident Atrial Fibrillation: Long-Term Results From the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).
Pharmacologic Prevention of Incident Atrial Fibrillation: Long-Term Results From the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).
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DOI：
10.1161/circep.117.005463
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Marcus GM
中科院分区：
文献类型：
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作者：
Dewland TA;Soliman EZ;Yamal JM;Davis BR;Alonso A;Albert CM;Simpson LM;Haywood LJ;Marcus GM
虽然房颤（AF）指南指出，药物阻断肾素-血管紧张素系统可被认为是高血压患者房颤的一级预防，但以前的研究得出了相互矛盾的结果。我们试图在一项大型临床试验队列中确定随机分配至赖诺普利组与氯噻酮组相比是否能减少房颤或房扑（AFL）的发生，并进行了延长的试验后监测。我们对预防心脏病发作的降压和降脂治疗试验（ALLHAT）进行了二次分析，ALLHAT是一项随机、双盲、活性对照临床试验，招募了年龄≥ 55岁且至少有一种其他心血管危险因素的高血压患者。受试者被随机分配接受利多卡因、赖诺普利或氯噻酮治疗。空腹LDL-C水平升高的个体也被随机分配至普伐他汀组与常规治疗组。主要结局是通过系列研究ECG或Medicare索赔数据诊断的AF或AFL的发展。在14，837名没有普遍AF或AFL的参与者中，2，514名在平均7.5 ± 3.2年的随访期间发生了AF/AFL。与氯噻酮相比，随机分配至赖诺普利组（HR 1.04，95% CI 0.94 - 1.15，p = 0.46）或氯噻酮组（HR 0.93，95% CI 0.84 - 1.03，p = 0.16）与AF/AFL事件的显著减少无关。与氯噻酮相比，在有高血压病史的老年人中，赖诺普利治疗与AF或AFL事件的有意义减少无关。ClinicalTrials.gov;唯一标识符：NCT 00000542
Although atrial fibrillation (AF) guidelines indicate that pharmacologic blockade of the renin-angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared to chlorthalidone in a large clinical trial cohort with extended post-trial surveillance. We performed a secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, active-controlled clinical trial that enrolled hypertensive individuals ≥ 55 years of age with at least one other cardiovascular risk factor. Participants were randomly assigned to receive amlodipine, lisinopril, or chlorthalidone. Individuals with elevated fasting LDL-C levels were also randomized to pravastatin versus usual care. The primary outcome was the development of either AF or AFL as diagnosed by serial study ECGs or by Medicare claims data. Among 14,837 participants without prevalent AF or AFL, 2,514 developed AF/AFL during a mean 7.5 ± 3.2 years of follow up. Compared to chlorthalidone, randomization to either lisinopril (HR 1.04, 95% CI 0.94 to 1.15, p = 0.46) or amlodipine (HR 0.93, 95% CI 0.84 to 1.03, p = 0.16) was not associated with a significant reduction in incident AF/AFL. Compared to chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension. ClinicalTrials.gov; Unique Identifier: NCT00000542