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 mmHg和/或 舒张压[DBP]大于或等于90 mmHg），或 服用降压药所有考虑因素和剩余 恒定，治疗2500万患者的增量成本， 每患者年治疗费用为100美元的药物， 500美元/患者年的治疗费用是100亿美元。高血压（HTN）是 非裔美国人比高加索人更常见， 后遗症在非裔美国人中更为常见和严重。Allhat是 一项全国性的、基于实践的、随机的临床试验， 抗高血压药物治疗和降低胆固醇 40，000名高风险高血压患者的特定子集，包括 55%的非洲裔美国人。降压试验的目的 这一部分的目的是确定致命的 冠心病（CHD）和非致死性心肌梗死（MI） 利尿剂（氯噻酮）治疗和三种 替代的，更昂贵的抗高血压药物治疗- 钙拮抗剂（CGRP）和血管紧张素转换酶 抑制剂（ACE-1）（赖诺普利）和α-肾上腺素能阻滞剂 （多沙唑嗪）。由于抗高血压药物的既定益处 治疗减少中风，总发病率和死亡率， 心血管疾病（CVD）和全因死亡率， 抗高血压试验部分不包括安慰剂。目的 降低胆固醇试验的目的是确定 降低中度高胆固醇血症男性的血清胆固醇， 60岁及以上3-羟甲基戊二酰辅酶女性 一种（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。" 两项试验的次要目的是比较 其各自治疗方案对CV死亡率、主要发病率 健康成本，以及各自治疗方案对 CV死亡率、主要发病率、医疗成本和健康相关质量 生命两个试验部分的其他次要目的是 比较替代治疗对全因死亡率的影响， 主要的HTN相关的发病率，如左心室的发病率和消退， 心室肥大和进行性肾功能不全。额外 降脂试验的次要目的是评估 HMG CoA还原酶抑制剂在60岁男性和女性中的长期安全性 年及以上（特别是关于非CV 原因），降脂对癌症发病率和死亡率的影响， 以及致死性CHD和非致死性MI的联合发病率，尤其是 在关键亚组（非裔美国人[自称为“黑人”]， 65岁，女性，II型糖尿病患者）。预计本试验的平均持续时间 是六年。

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.