ANTIHYPERTENSIVE AND LIPID LOWERING TREATMENT TO PREVENT HEART ATTACK

三种新型降压药赖诺普利、氨氯地平和多沙唑辛与标准形式利尿剂的疗效比较。据估计，美国有5000万人患有高血压或正在服用治疗高血压的药物。高血压与冠心病(CHD)之间的关系是已知的，但在以中年人为主的轻度至中度高血压患者中进行的大规模随机临床试验未能表明，高血压药物治疗减少了心脏病死亡或非致命性心肌梗死(由于该地区缺乏血液供应而导致的心脏组织死亡)的发生。这项试验的主要假设是，在接受这三种药物治疗的高血压患者中，致命性心脏病和非致命性心肌梗死的综合发病率将较低。这项研究将涉及55岁及以上的男性和女性，除高血压外，他们都至少有一个额外的冠心病风险因素，其中55%将是更容易患高血压的非裔美国人。将有一个降低血压的试验成分和一个降低胆固醇的试验成分。研究药物将随机分配。患者将每隔四周接受一次检查，直到达到相当稳定的治疗方案和令人满意的血压控制。然后，在第一年每三个月进行一次诊所就诊，此后每四个月进行一次。每次就诊时都要测量血压。2号会诊时要做心电图检查。钾水平将在一个月、一年、两年、四年和六年进行检查。将进行血液测试，以及肌酐、空腹胆固醇和血糖的测试。在每次就诊时，都将确定研究药物的依从性。生活质量将在研究开始时和此后每年讨论。

A determination of effectiveness of three new blood pressure-lowering drugs; lisinopril, amlodipine, and doxazocin as compared to the standard forms of treatment with diuretic drugs. An estimated 50 million people in the United States have elevated blood pressure or are taking medications for high blood pressure. There is known relationship between high blood pressure and coronary heart disease (CHD), but large-scale, randomized clinical trials in mild to moderately high blood pressure in largely middle-aged subjects failed to show that high blood pressure drug treatment reduces the occurrence of cardiac disease death or non-fatal myocardial infarction (the death of heart tissue due to lack of blood supply to the area). The primary hypothesis of this trial is that the combined incidence of fatal heart disease and non-fatal myocardial infarction will be lower in patients with high blood pressure who receive the three medications. The study will involve a population of men and women 55 years and older, all with at least one additional CHD risk factor besides high blood pressure, 55% of whom will be African-American, a race more prone to high blood pressure. There will be a trial component to lower blood pressure and a trial component to lower cholesterol. Study drugs will be randomly assigned. Patients will be seen at four week intervals until a reasonably stable regimen with satisfactory blood pressure control has been achieved. Clinic visits will then take place every three months during the first year and every four months thereafter. Blood pressure will be taken at each visit. An electrocardiogram test will be given at visit two. Potassium levels will be checked at one month, one year, two years, four years, and at six years. Blood tests will be done as well as tests for creatinine serum., fasting cholesterol, and serum glucose. At every visit, a determination of compliance with study medications will be done. Quality of life will be discussed at the entry of the study and every year thereafter.