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首页> 外文期刊>JAMA: the Journal of the American Medical Association >Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group (see comments)
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Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group (see comments)

机译：高血压患者的主要心血管事件随机分配为多沙唑嗪与氯噻酮：抗高血压和降脂治疗，以预防心脏病发作试验（ALLHAT）。 ALLHAT合作研究小组（请参阅评论）

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CONTEXT: Hypertension is associated with a significantly increased risk of morbidity and mortality. Only diuretics and beta-blockers have been shown to reduce this risk in long-term clinical trials. Whether newer antihypertensive agents reduce the incidence of cardiovascular disease (CVD) is unknown. OBJECTIVE: To compare the effect of doxazosin, an alpha-blocker, with chlorthalidone, a diuretic, on incidence of CVD in patients with hypertension as part of a study of 4 types of antihypertensive drugs: chlorthalidone, doxazosin, amlodipine, and lisinopril. DESIGN: Randomized, double-blind, active-controlled clinical trial, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, initiated in February 1994. In January 2000, after an interim analysis, an independent data review committee recommended discontinuing the doxazosin treatment arm based on comparisons with chlorthalidone. Therefore, outcomes data presented herein reflect follow-up through December 1999. SETTING: A total of 625 centers in the United States and Canada. PARTICIPANTS: A total of 24,335 patients (aged > or = 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor who received either doxazosin or chlorthalidone. INTERVENTIONS: Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n=15,268), or doxazosin, 2 to 8 mg/d (n=9067), for a planned follow-up of 4 to 8 years. MAIN OUTCOME MEASURES: The primary outcome measure was fatal CHD or nonfatal myocardial infarction (MI), analyzed by intent to treat; secondary outcome measures included all-cause mortality, stroke, and combined CVD (CHD death, nonfatal MI, stroke, angina, coronary revascularization, congestive heart failure [CHF], and peripheral arterial disease); compared by the chlorthalidone group vs the doxazosin group. RESULTS: Median follow-up was 3.3 years. A total of 365 patients in the doxazosin group and 608 in the chlorthalidone group had fatal CHD or nonfatal MI, with no difference in risk between the groups (relative risk [RR], 1.03; 95% confidence interval [CI], 0.90-1.17; P=.71). Total mortality did not differ between the doxazosin and chlorthalidone arms (4-year rates, 9.62% and 9.08%, respectively; RR, 1.03; 95% CI, 0.90-1.15; P=.56.) The doxazosin arm, compared with the chlorthalidone arm, had a higher risk of stroke (RR, 1.19; 95% CI, 1.01-1.40; P=.04) and combined CVD (4-year rates, 25.45% vs 21.76%; RR, 1.25; 95% CI, 1.17-1.33; P<.001). Considered separately, CHF risk was doubled (4-year rates, 8.13% vs 4.45%; RR, 2.04; 95% CI, 1.79-2.32; P<.001); RRs for angina, coronary revascularization, and peripheral arterial disease were 1.16 (P<.001), 1.15 (P=.05), and 1.07 (P=.50), respectively. CONCLUSION: Our data indicate that compared with doxazosin, chlorthalidone yields essentially equal risk of CHD deathonfatal MI but significantly reduces the risk of combined CVD events, particularly CHF, in high-risk hypertensive patients.
机译：背景：高血压与发病和死亡的风险显着增加有关。在长期的临床试验中，仅利尿剂和β受体阻滞剂可降低这种风险。新型降压药是否能降低心血管疾病（CVD）的发病率尚不清楚。目的：比较氯噻酮，多沙唑嗪，氨氯地平和赖诺普利这四种类型的降压药的一部分，比较α-受体阻断剂多沙唑嗪和利尿剂氯噻酮对高血压患者CVD的影响。设计：于1994年2月启动的一项随机，双盲，主动控制的临床试验，抗高血压和降脂治疗预防心脏病发作试验。2000年1月，经过中期分析，一个独立的数据审查委员会建议停用多沙唑嗪治疗组基于与氯噻酮的比较。因此，本文提供的结果数据反映了截至1999年12月的随访情况。地点：美国和加拿大共有625个中心。参与者：共有24,335名患有高血压和至少1种其他冠心病（CHD）危险因素的患者（接受多沙唑嗪或氯噻酮治疗）（年龄≥55岁）。干预措施：参加者被随机分配接受12.5至25 mg / d的氯噻酮（n = 15,268）或2至8 mg / d的多沙唑嗪（n = 9067），计划随访4至8年。主要观察指标：主要观察指标为致命性冠心病或非致命性心肌梗塞（MI），并根据治疗意图进行分析。次要结果指标包括全因死亡率，中风和合并CVD（CHD死亡，非致命性MI，中风，心绞痛，冠状动脉血运重建，充血性心力衰竭[CHF]和周围动脉疾病）;氯噻酮组和多沙唑嗪组比较。结果：中位随访时间为3.3年。多沙唑嗪组中的365名患者和氯噻酮组中的608名患者致命CHD或非致命性MI，两组之间的风险无差异（相对风险[RR]为1.03; 95％置信区间[CI]为0.90-1.17） ; P = .71）。多沙唑嗪组和氯噻酮组的总死亡率无差异（4年率，分别为9.62％和9.08％; RR，1.03; 95％CI，0.90-1.15; P = .56。）氯噻酮组发生中风的风险更高（RR，1.19; 95％CI，1.01-1.40; P = .04）和合并CVD（4年率，25.45％vs 21.76％; RR，1.25; 95％CI， 1.17-1.33; P <.001）。单独考虑，瑞士法郎风险增加了一倍（4年率，8.13％对4.45％; RR，2.04; 95％CI，1.79-2.32; P <.001）;心绞痛，冠状动脉血运重建和外周动脉疾病的RRs分别为1.16（P <.001），1.15（P = .05）和1.07（P = .50）。结论：我们的数据表明，与多沙唑嗪相比，氯噻酮产生的CHD死亡/非致死性MI风险基本相同，但可显着降低高危高血压患者合并CVD事件（尤其是CHF）的风险。

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