HYDROCHLOROTHIAZIDE AND CHLORTHALIDONE ON BLOOD PRESSURES

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。最近来自抗高血压和降脂预防心脏病发作试验（ALLHAT）的证据表明，与新的抗高血压药物（如血管紧张素转换酶抑制剂和钙通道阻滞剂）相比，噻嗪类利尿剂的初始治疗可显著降低卒中和冠心病事件。氯噻酮是ALLHAT中使用的噻嗪类利尿剂，传统上是许多具有里程碑意义的高血压临床试验中使用的利尿剂。然而，氢氯噻嗪（HCTZ）是美国临床实践中常用的噻嗪类利尿剂。虽然大多数临床医生认为HCTZ和氯噻酮在临床上是可互换的，但缺乏直接比较这些药物的数据。这是一项为期8周、开放标签、交叉试验，比较HCTZ与氯噻酮对诊室血压和动态血压的降压作用。将从爱荷华州大学家庭护理中心的两个初级保健实践中招募符合入选标准的原发性高血压男性和女性。在2-4周洗脱期（在此期间，患者将每周返回诊所进行血压测量）后，患者将接受基线动态血压监测，并随机分配至HCTZ 25 mg/d或氯噻酮12.5 mg/d组。患者将每两周返回诊所进行血压测量和/或实验室测量和/或剂量滴定（氯噻酮最大剂量为25 mg，HCTZ最大剂量为50 mg）。将在第8周重复进行动态血压监测。在完成研究的第一组后，患者将再次经历第二个2-4周的洗脱期，并进入与第一组相同但使用相反药物的研究的相反组。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Recent evidence from the Antihypertensive and Lipid-Lowering to Prevent Heart Attack Trial (ALLHAT) suggests initial therapy with a thiazide-type diuretic confers significantly higher reductions in stroke and coronary heart disease events compared to newer antihypertensive agents such as angiotensin-converting enzyme inhibitors and calcium channel blockers. Chlorthalidone, the thiazide-type diuretic utilized in ALLHAT, has traditionally been the diuretic utilized in many of the landmark clinical trials in hypertension. However, hydrochlorothiazide (HCTZ) is the thiazide diuretic typically used in clinical practice in the United States. Although most clinicians assume HCTZ and chlorthalidone are clinically interchangeable, there is a lack of data comparing these agents directly to one another. This is an 8-week, open-label, crossover trial comparing the antihypertensive effects of HCTZ versus chlorthalidone on both office-based and ambulatory blood pressures. Men and women with essential hypertension and meeting inclusion criteria will be recruited from two primary care practices at the University of Iowa Family Care Center. After a 2-4 week washout period during which time patients will return for weekly office blood pressure measurements, patients will then undergo a baseline ambulatory blood pressure monitoring session and be randomized to either HCTZ 25 mg/d or chlorthalidone 12.5 mg/d. Patients will return biweekly for office blood pressure measurements, and/or laboratory measurements, and/or dosage titration (to a max dose of 25 mg for chlorthalidone and 50 mg of HCTZ). Ambulatory blood pressure monitoring will be repeated at week 8. Following completion of the first arm of the study, patients will again undergo a second 2-4 week washout period and proceed into the opposite arm of the study which is identical to the first arm but with the opposite medication.