Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients
Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients
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DOI：
10.1056/nejmoa0806182
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发表时间：
2008-12-04
影响因子：
158.5
通讯作者：
Velazquez, Eric J.
中科院分区：
文献类型：
--
作者：
Jamerson, Kenneth;Weber, Michael A.;Velazquez, Eric J.
背景资料：高血压的最佳联合药物治疗尚未确定，尽管目前美国指南建议包括利尿剂。我们假设联合使用血管紧张素转换酶（ACE）抑制剂和二氢吡啶类钙通道阻滞剂比联合使用ACE抑制剂和噻嗪类利尿剂更有效地降低心血管事件的发生率。在一项随机双盲试验中，我们分配了11名，506例心血管事件高风险的高血压患者接受苯那普利加氯吡格雷或苯那普利加氢氯噻嗪治疗。主要终点为心血管原因死亡、非致死性心肌梗死、非致死性卒中、心绞痛住院、心脏骤停后复苏和冠状动脉血运重建。在平均随访36个月后，当超过预先规定的停止规则的界限时，试验提前终止。剂量调整后，贝那普利-氢氯噻嗪组的平均血压为131.6/73.3 mm Hg，贝那普利-氢氯噻嗪组为132.5/74.4 mm Hg。贝那普利-氢氯噻嗪组有552例主要结局事件（9.6%），贝那普利-氢氯噻嗪组有679例（11.8%），代表贝那普利-氢氯噻嗪治疗的绝对风险降低2.2%，相对风险降低19.6%（危害比，0.80，95%可信区间[CI]，0.72 - 0.90; P
Background: The optimal combination drug therapy for hypertension is not established, although current U.S. guidelines recommend inclusion of a diuretic. We hypothesized that treatment with the combination of an angiotensin-converting-enzyme (ACE) inhibitor and a dihydropyridine calcium-channel blocker would be more effective in reducing the rate of cardiovascular events than treatment with an ACE inhibitor plus a thiazide diuretic.Methods: In a randomized, double-blind trial, we assigned 11,506 patients with hypertension who were at high risk for cardiovascular events to receive treatment with either benazepril plus amlodipine or benazepril plus hydrochlorothiazide. The primary end point was the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac arrest, and coronary revascularization.Results: The baseline characteristics of the two groups were similar. The trial was terminated early after a mean follow-up of 36 months, when the boundary of the prespecified stopping rule was exceeded. Mean blood pressures after dose adjustment were 131.6/73.3 mm Hg in the benazepril-amlodipine group and 132.5/74.4 mm Hg in the benazepril-hydrochlorothiazide group. There were 552 primary-outcome events in the benazepril-amlodipine group (9.6%) and 679 in the benazepril-hydrochlorothiazide group (11.8%), representing an absolute risk reduction with benazepril-amlodipine therapy of 2.2% and a relative risk reduction of 19.6% (hazard ratio, 0.80, 95% confidence interval [CI], 0.72 to 0.90; P