氯噻酮、氨氯地平和赖诺普利治疗黑人和非黑人高血压患者的预后比较

作     者：Wright Jr. J. T. Dunn J. K. Cutler J. A. 杜媛 

作者机构：General Clinical Research Center Case Western Reserve University Bowell Bldg. 11000 Euclid Ave Cleveland OH 44106 United States Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第11期

页      面：22-23页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：赖诺普利 氯噻酮 噻嗪类利尿剂 目标血压 临床终点 全因死亡 非致死性 心血管疾病 联合终点 阳性药物 

摘      要：Context Few cardiovascular outcome data are available for blacks with hypertension treated with angiotensin-conver-ting enzyme(ACE) inhibitors or calcium channel blockers(CCBs). Objective To determine whether an ACE inhibitor or CCB is superior to a thiazide-type diuretic in reducing cardiovascular disease(CVD) incidence in racial subgroups. Design, Setting, and Participants Prespecified subgroup analysis of ALLHAT, a randomized, double-blind, active-controlled, clinical outcome trial conducted between February 1994 and March 2002 in 33 357 hypertensive US and Canadian patients aged 55 years or older(35%black) with at least 1 other cardiovascular risk factor. Interventions Antihypertensive regimens initiated with a CCB(amlodipine) or an ACE inhibitor(lisinopril) vs a thiazide-type diuretic(chlorthalidone). Other medications were added to achieve goal blood pressures(BPs) less than 140/90 mmHg. Main Outcome Measures The primary outcome was combined fatal coronary heart disease(CHD) or nonfatal myocardial infarction(MI), analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined CVD(CHD death, nonfatal MI, stroke, angina, coronary revascularization, heart failure HF , or peripheral vascular disease), and end-stage renal disease. Results No significant difference was found between treatment groups for the primary CHD outcome in either racial subgroup. For amlodipine vs chlorthalidone only, HF was the only prespecified clinical outcome that differed significantly(overall: relative risk RR , 1.37; 95%confidence interval CI , 1.24-1.51; blacks: RR, 1.46; 95%CI, 1.24-1.73; nonblacks: RR, 1.32; 95%CI, 1.17-1.49; P .001 for each comparison) with no difference in treatment effects by race(P=.38 for interaction). For lisinopril vs chlorthalidone, results differed by race for systolic BP(greater decrease in blacks with chlorthalidone), stroke, and combined CVD outcomes(P .001, P=.01, and P=.04, respectively, for interactions). In blacks