ANTIHYPERTENSIVE LIPID-LOWERING HEART ATTACK PREVENTION THERAPY

据估计，美国有5000万人患有高血压（收缩压[SBP] >140mmHg和/或舒张压[DBP] >90mmHg），或正在服用抗高血压药物。考虑到所有因素并保持不变，用100美元/患者-年的药物治疗2500万患者的增量成本与500美元/患者-年的药物治疗相比为100亿美元。高血压被认为在非裔美国人中比白种人更常见，其后遗症在非裔美国人中也更常见。因此，ALLHAT试验是一项全国性的、基于实践的、随机的临床试验，目的是通过降压药物治疗和降胆固醇来预防4万名高危高血压患者的心脏病发作，该试验至少包括55%的非裔美国人。降压治疗组的目的是确定利尿剂治疗和三种替代降压药物治疗（更昂贵）之间致死性冠心病和非致死性心肌梗死的合并发生率。降脂治疗组的目的是确定与接受“常规护理”的对照组相比，使用特定的3-羟甲基戊二酰辅酶a还原酶抑制剂降低60岁及以上的中度高胆固醇血症男性和女性的血清胆固醇是否会降低全因死亡率。两个试验组成部分的次要目标是比较各自治疗方案对心血管死亡率、主要发病率、医疗成本和与健康相关的生活质量的影响。

An estimated 50 million people in the U.S. have high blood pressure (systolic blood pressure [SBP] >140mmHg and/or diastolic BP [DBP] >90mmHg), or are taking antihypertensive medications. All factors considered and remaining constant, the incremental cost of treating 25 million patients with a drug costing $100/patient-year of therapy compared to one costing $500/patient-year of therapy is $10 billion. Hypertension is considered more frequent among African Americans than Caucasians, and its sequelae are also seen more frequently in African Americans. Thus, the ALLHAT trial, a nationwide, practice-based, randomized clinical trial of antihypertensive pharmacological treatments and cholesterol-lowering to prevent heart attacks in a specific subset of 40,000 high-risk hypertensive patients, is to include at least 55% African Americans. The purpose of the antihypertensive treatment arm is to determine the combined incidence of fatal coronary heart disease and non-fatal myocardial infarction between diuretic treatment and three alternative (and more expensive) antihypertensive pharmacological treatments. The purpose of the lipid-lowering treatment arm is to determine if lowering serum cholesterol in moderately hypercholesterolemic men and women aged 60 years and older, with a specific 3-hydroxymethylglutaryl coenzyme A reductase inhibitor, 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 cardiovascular mortality, major morbidity, health costs, and health-related quality of life.