Heart failure with preserved and reduced left ventricular ejection fraction in the antihypertensive and lipid-lowering treatment to prevent heart attack trial.
Heart failure with preserved and reduced left ventricular ejection fraction in the antihypertensive and lipid-lowering treatment to prevent heart attack trial.
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DOI：
10.1161/circulationaha.107.762229
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发表时间：
2008-11-25
期刊：
影响因子：
37.8
通讯作者：
ALLHAT Collaborative Research Group
中科院分区：
文献类型：
--
作者：
Davis BR;Kostis JB;Simpson LM;Black HR;Cushman WC;Einhorn PT;Farber MA;Ford CE;Levy D;Massie BM;Nawaz S;ALLHAT Collaborative Research Group
高血压患者发生的心衰（HF）可能伴有左心室射血分数保留或降低[射血分数保留（≥50%）或射血分数降低（<50%）]。在抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）中，42418名高危高血压患者被随机分配接受氯噻酮、氨氯地平、赖诺普利或多沙唑嗪治疗，这为比较这些治疗在住院心衰射血分数保留型（HFPEF）或射血分数降低型（HFREF）发生方面的情况提供了机会。
心衰诊断标准在ALLHAT方案中预先设定。在符合ALLHAT标准的1367例住院事件患者中，有910例（66.6%）可通过心室造影、超声心动图或放射性核素研究估计射血分数。采用针对基线特征进行调整的Cox回归模型来检验心衰治疗的差异（总体以及按射血分数保留和射血分数降低分类）。还检验了心衰病死率。在有射血分数数据的患者中，44.4%为HFPEF，55.6%为HFREF。与氨氯地平、赖诺普利或多沙唑嗪相比，氯噻酮降低了HFPEF的风险；风险比[HRs]和95%置信区间分别为0.69（0.53 - 0.91；p = 0.009）、0.74（0.56 - 0.97；p = 0.032）和0.53（0.38 - 0.73；p < 0.001）。与氨氯地平或多沙唑嗪相比，氯噻酮降低了HFREF的风险；HRs分别为0.74（0.59 - 0.94；p = 0.013）和0.61（0.47 - 0.79；p < 0.001）。氯噻酮在HFREF发生率方面与赖诺普利相似；HR = 1.07（0.82 - 1.40；p = 0.596）。在心衰发作后，新发HFPEF的参与者（氯噻酮/氨氯地平/赖诺普利）中有29.2%死亡，而HFREF患者中有41.9%死亡，p < 0.001（中位随访1.74年）；在提前终止的氯噻酮/多沙唑嗪比较中，20.0%（HFPEF）对26.0%（HFREF），p = 0.185（中位随访1.55年）。
在ALLHAT试验中，使用判定结果，与氨氯地平和多沙唑嗪相比，氯噻酮显著降低了新发住院HFPEF和HFREF的发生。与赖诺普利相比，氯噻酮也降低了新发HFPEF的发生率。在高危高血压男性和女性中，HFPEF的预后比HFREF更好。
Heart failure (HF) developing in hypertensive patients may occur with preserved or reduced left ventricular ejection fraction [PEF (≥50%) or REF (<50%)]. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), 42,418 high-risk hypertensive patients were randomized to chlorthalidone, amlodipine, lisinopril, or doxazosin, providing an opportunity to compare these treatments with regard to occurrence of hospitalized HFPEF or HFREF. HF diagnostic criteria were pre-specified in the ALLHAT protocol. EF estimated by contrast ventriculography, echocardiography or radionuclide study was available in 910 (66.6%) of 1367 patients with hospitalized events meeting ALLHAT criteria. Cox regression models adjusted for baseline characteristics were used to examine treatment differences for HF (overall and by PEF and REF). HF case-fatality rates were examined. Of those with EF data, 44.4% had HFPEF and 55.6% had HFREF. Chlorthalidone reduced the risk of HFPEF compared with amlodipine, lisinopril, or doxazosin; the hazard ratios [HRs] and 95% CIs were 0.69 (0.53-0.91; p=0.009), 0.74 (0.56-0.97; p=0.032), and 0.53 (0.38-0.73; p<0.001), respectively. Chlorthalidone reduced the risk of HFREF compared with amlodipine or doxazosin; HRs were 0.74 (0.59-0.94; p=0.013) and 0.61 (0.47-0.79; p<0.001), respectively. Chlorthalidone was similar to lisinopril with regard to incidence of HFREF; HR=1.07 (0.82-1.40; p=0.596). Following HF onset, death occurred in 29.2% of participants (chlorthalidone/amlodipine/lisinopril) with new-onset HFPEF versus 41.9% in those with HFREF, p<0.001 (median follow-up 1.74 years); and in the terminated early chlorthalidone/doxazosin comparison 20.0% (HFPEF) versus 26.0% (HFREF), p=0.185 (median follow-up 1.55 years). In the ALLHAT trial, using adjudicated outcomes, chlorthalidone significantly reduced the occurrence of new-onset hospitalized HFPEF and HFREF compared with amlodipine and doxazosin. Chlorthalidone also reduced the incidence of new-onset HFPEF compared with lisinopril. Among high-risk hypertensive men and women, HFPEF has a better prognosis than HFREF.