ANTIHYPERTENSIVE LIPID-LOWERING HEART ATTACK PREVENTION THERAPY

据估计，美国有5000万人患有高血压(收缩压140毫米汞柱和/或舒张压90毫米汞柱)，或正在服用降压药。考虑到所有因素并保持不变，与500美元/患者年相比，用100美元/患者年治疗成本的药物治疗2500万患者的增量成本为100亿美元。高血压被认为在非裔美国人中比高加索人更常见，其后遗症在非裔美国人中也更常见。因此，ALLHAT试验将包括至少55%的非裔美国人。ALLHAT试验是一项全国性的、基于实践的随机临床试验，涉及抗高血压药物治疗和降低胆固醇以防止4万名高危高血压患者中的特定子集的心脏病发作。抗高血压治疗臂的目的是确定利尿剂治疗和三种替代(且更昂贵的)抗高血压药物治疗之间致命性冠心病和非致命性心肌梗死的综合发生率。降脂治疗的目的是确定在60岁及以上的中度高胆固醇血症的男性和女性中，使用一种特殊的3-羟甲基戊二酰辅酶A还原酶抑制剂降低血清胆固醇是否会降低所有原因的死亡率，而不是接受“常规护理”的对照组。这两个试验部分的次要目标是比较它们各自的治疗方案对心血管死亡率、主要发病率、健康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.