ANTIHYPERTENSIVE & LIPID LOWERING THERAPY TO PREVENT HEART ATTACK TRIAL

据估计，美国有5000万人患有高血压 (收缩压[SBP]大于或等于140毫米汞柱和/或 舒张压[DBP]大于或等于90毫米汞)，或 服用降压药。考虑的所有因素和剩余的因素 不变，治疗2500万名患者的增量成本 每名患者一年的治疗费用为100美元，而一次治疗的费用为100美元 每名患者500美元-治疗一年是100亿美元。高血压(HTN)是 在非裔美国人中比高加索人更常见，而且它 后遗症在非裔美国人中更为常见和严重。哈哈特是 一项全国性的、基于实践的、随机的、临床试验 抗高血压药物治疗与降胆固醇 包括AT在内的40,000名高危高血压患者的特定亚组 至少55%的非裔美国人。抗高血压试验的目的 组成部分是确定致命性死亡的综合发病率 冠心病(CHD)和非致命性心肌梗塞(MI) 利尿剂(氯苯吡酮)治疗与三种药物之间的差异 替代的、更昂贵的降压药物治疗--a 钙拮抗剂(氨氯地平)和血管紧张素转换酶 血管紧张素转换酶抑制剂(ACE-1)(赖诺普利)和α-肾上腺素能阻滞剂 (多沙唑嗪)。因为抗高血压的既定益处 治疗在减少中风、总发病率和死亡率方面的作用 心血管疾病(CVD)和全因死亡， 抗高血压试验成分将不包括安慰剂。目的 降胆固醇试验的成分是确定是否 降低中度高胆固醇血症男性的血清胆固醇和 患有3-羟甲基戊二酰辅酶的60岁及以上女性 A(HMG CoA)还原酶抑制剂普伐他汀将减少所有原因 死亡率与接受“常规护理”的对照组相比。 这两个试验部分的次要目标是比较效果 他们各自的治疗方案对心血管病死率、主要发病率、 医疗成本，以及他们各自的治疗方案对 心血管疾病死亡率、主要发病率、医疗费用和健康相关质量 生活的一部分。这两个试验部分的其他次要目标是 比较替代疗法对全因死亡率和 与HTN相关的主要发病率，如左冠状动脉病变的发生率和消退率 心肌肥厚和进行性肾功能不全。其他内容 降脂试验的次要目标是评估 HMG辅酶A还原酶抑制剂对60岁男性和女性的长期安全性 年及以上(特别是关于非心血管疾病的死亡率 原因)，降脂对癌症发病率和死亡率的影响， 以及致命性冠心病和非致命性心肌梗死的联合发病率，特别是 在关键亚群中(非裔美国人[自称“黑人”]，年龄以上 65，女性，II型糖尿病患者)。预计这项试验的平均持续时间 是6年。

An estimated 50 million people in the U.S. have high blood pressure (systolic blood pressure [SBP] greater or equal to 140mmHg and/or diastolic blood pressure [DBP] greater or equal to 90 mmHg), or are taking antihypertensive medications. All factors considered and remaining constant, the incremental cost of treating 25 million patients with a drug costing $ 100 per patient-year of therapy compared to one costing $500 per patient-year of therapy is $10 billion. Hypertension (HTN) is considerably more common among African Americans than Caucasians, and its sequelae are more frequent and severe among African Americans. ALLHAT is a nationwide, practice-based, randomized, clinical trial of antihypertensive pharmacological treatments and cholesterol lowering--in a specific subset of 40,000 high-risk hypertensive patients including at least 55% African Americans. The purpose of the antihypertensive trial component is to determine whether the combined incidence of fatal coronary heart disease (CHD) and non-fatal myocardial infarction (MI) differs between diuretic (chlorthalidone) treatment and three alternative, more expensive antihypertensive pharmacologic treatments--a calcium antagonist (amlodipine), and angiotensin converting enzyme inhibitor(ACE-1) (lisinopril), and an alpha-adrenergic blocker (doxazosin). Because of the established benefit of antihypertensive treatment in reduction of stroke, total morbidity and mortality from cardiovascular diseases (CVD), and all-causes mortality, the antihypertensive trial component will not include a placebo. The purpose of the cholesterol lowering trial component is to determine whether lowering serum cholesterol in moderately hypercholesterolemic men and women aged 60 years and older with the 3-hydroxmethlglutaryl co-enzyme A (HMG CoA) reductase inhibitor pravastatin will reduce all-cause mortality as compared to a control group receiving "usual care." Secondary objectives of both trial components are to compare the effects of their respective treatment regimens on CV mortality, major morbidity, health costs, and the effects of their respective treatment regimens on CV mortality, major morbidity, health costs, and health-related quality of life. Additional secondary objectives of both trial components are to compare the effects of alternative treatments on all-cause mortality and on major HTN-related morbidity such as incidence and regression of left ventricular hypertrophy and progressive renal dysfunction. Additional secondary objectives of the lipid-lowering trial are to assess the longterm safety of HMG CoA reductase inhibitors in men and women aged 60 years and above (particularly with regard to mortality from non-CV causes), the effect of lipid-lowering on cancer incidence and mortality, and on the combined incidence of fatal CHD and nonfatal MI, especially in key subgroups (African Americans [self-described "blacks"], over age 65, women, type II diabetics). Mean duration of this trial is expected to be 6 years.