Rationale and design for the antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT)
Rationale and design for the antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT)
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DOI：
10.1016/0895-7061(96)00037-4
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发表时间：
1996-04-01
影响因子：
3.2
通讯作者：
Hawkins, CM
中科院分区：
文献类型：
--
作者：
Davis, BR;Cutler, JA;Hawkins, CM
在降低冠心病发病率和进展方面，新型降压药与利尿剂一样好或更好吗？目前，新型降压药的平均购买成本更高。在中度高胆固醇血症的老年人中降低低密度脂蛋白胆固醇会降低心血管疾病的发病率和总死亡率吗？这些重要的医疗实践和公共卫生问题将通过抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）来解决，这是一项随机，双盲试验，在40,000名高危高血压患者中进行。ALLHAT旨在确定在随机接受利尿剂（氯噻酮）治疗和三种替代治疗（钙拮抗剂（氨氯地平）、血管紧张素转换酶抑制剂（赖诺普利）和肾上腺素受体阻滞剂（多沙唑嗪））的人群中，致死性冠心病（CHD）和非致死性心肌梗死的联合发病率是否存在差异。ALLHAT还包含一项随机、开放标签的降脂试验，旨在确定使用3-羟甲基戊二酰辅酶a （HMG CoA）还原酶抑制剂普伐他汀降低20,000名中度高胆固醇血症患者（40,000名患者中的一个亚群）的LDL胆固醇，与接受“常规护理”的对照组相比，是否会降低全因死亡率。“ALLHAT的主要资格标准是：1)55岁或以上；2)收缩期或舒张期高血压；3)心脏病发作的一个或多个危险因素，动脉粥样硬化性疾病或II型糖尿病的证据)。在降脂试验中，参与者的低密度脂蛋白胆固醇必须在120到189毫克/分升之间（已知冠心病患者必须在100到129毫克/分升之间），甘油三酯水平必须低于350毫克/分升。平均治疗和随访时间计划为6年。本文描述了ALLHAT的基本原理、设计、目标、治疗方案和研究组织的进一步特点。
Are newer types of antihypertensive agents, which are currently more costly to purchase on average, as good or better than diuretics in reducing coronary heart disease incidence and progression? Will lowering LDL cholesterol in moderately hypercholesterolemic older individuals reduce the incidence of cardiovascular disease and total mortality?These important medical practice and public health questions are to be addressed by the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind trial in 40,000 high-risk hypertensive patients. ALLHAT is designed to determine whether the combined incidence of fatal coronary heart disease (CHD) and nonfatal myocardial infarction differs between persons randomized to diuretic (chlorthalidone) treatment and each of three alternative treatments-a calcium antagonist (amlodipine), an angiotensin converting enzyme inhibitor (lisinopril), and an Lu-adrenergic blocker (doxazosin). ALLHAT also contains a randomized, open-label, lipid-lowering trial designed to determine whether lowering LDL cholesterol in 20,000 moderately hypercholesterolemic patients (a subset of the 40,000) with a 3-hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitor, pravastatin, will reduce all-cause mortality compared to a control group receiving ''usual care.''ALLHAT's main eligibility criteria are: 1) age 55 or older; 2) systolic or diastolic hypertension; and 3) one or more additional risk factors for heart attack leg, evidence of atherosclerotic disease or type II diabetes). For the lipid-lowering trial, participants must have an LDL cholesterol of 120 to 189 mg/dL (100 to 129 mg/dL for those with known CHD) and a triglyceride level below 350 mg/dL. The mean duration of treatment and follow-up is planned to be 6 years. Further features of the rationale, design, objectives, treatment program, and study organization of ALLHAT are described in this article.