allhat.ppt - hypertension online課件

TheAntihypertensiveandLipid LoweringTreatmenttoPreventHeartAttackTrial ALLHATstudyoverviewDouble blind randomizedtrialtodeterminewhethertheoccurrenceoffatalCHDornonfatalMIislowerforhigh riskhypertensivepatientstreatedwithneweragents amlodipine lisinopril ordoxazosin comparedwithadiuretic chlorthalidone Cohort42 418patients 55yearsold from623sitesinNorthAmericaStage1or2hypertension1additionalriskfactorforCHDComparisonsbetweenchlorthalidoneandamlodipineandchlorthalidoneandlisinoprilhavebeenreportedtogether excludingthedoxazosinarm n 9 062 whichwasterminatedearly ALLHATResearchGroup JAMA 2002 288 2981 2997 www hypertensiononline org CHD coronaryheartdisease MI myocardialinfarction ALLHATStudyDesign n 13 8542 235 16 1 stoppeddrug Chlorthalidonen 15 255 Amlodipinen 9 048 Randomizedn 42 418 n 15 255339 2 2 losttofollow up80 0 5 refusedfollow up n 9 048200 2 2 losttofollow up58 0 6 refusedfollow up n 6 2101 873 30 2 stoppeddrug n 9 054218 2 4 losttofollow up58 0 6 refusedfollow up n 8 2151 357 16 5 stoppeddrug n 3 7691 052 27 9 stoppeddrug YEAR1 n 8 1581 842 22 6 stoppeddrug n 3 6051 399 38 8 stoppeddrug Lisinopriln 9 054 YEAR5 ALLHATResearchGroup JAMA 2002 288 2981 2997 www hypertensiononline org Intent to TreatAnalysis Doxazosinn 9 062 Discontinuedearlyat3 3yrs ALLHATEndpoints PrimaryendpointCompositeoffatalcoronaryheartdisease CHD ornonfatalmyocardialinfarction MI Otherpredefinedendpointsall causemortalitystrokecombinedCHD nonfatalMI CHDdeath coronaryrevascularization hospitalizedanginacombinedcardiovasculardisease combinedCHD stroke lowerextremityrevascularization treatedangina fatal hospitalized treatedcongestiveheartfailure hospitalizedoroutpatientperipheralarterialdiseaseother renal ALLHATResearchGroup JAMA 2002 288 2981 2997 www hypertensiononline org ALLHATBaselineCharacteristics ALLHATResearchGroup JAMA 2002 288 2981 2997 www hypertensiononline org BP bloodpressureCHD coronaryheartdisease ALLHATMeanSystolicandDiastolicBloodPressureDuringFollow up SystolicBP mmHg Follow up yrs DiastolicBP mmHg Chlorthalidone Amlodipine Lisinopril Chlorthalidone Amlodipine Lisinopril ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation www hypertensiononline org SBP systolicbloodpressureDBP diastolicbloodpressure Comparedtochlorthalidone DBPsignificantlylowerinamlodipinegroup 1mmHg Comparedtochlorthalidone SBPsignificantlyhigherinamlodipine 1mmHg andlisinopril 2mmHg groups ALLHATBPControlledto 140 90mmHg Lisinopril Amlodipine Chlorthalidone www hypertensiononline org ALLHATResearchGroup JAMA 2002 288 2981 2997 PatientswithBP 140 90mmHg P 0 001foramlodipinevschlorthalidone P 0 001forlisinoprilvschlorthalidone ALLHATTreatmentandBloodPressureControl 6mos 1yr 3yr 5yr 1Drug 2Drugs 3Drugs Patients CushmanWC etal JClinHypertens 2002 4 393 405 www hypertensiononline org Average ofdrugs 1 4 1 7 2 0 1 3 ALLHATPrimaryOutcomebyTreatmentGroup CumulativeFatalCHDandNonfatalMIeventrate Timetoevent yrs 0 1 2 3 4 5 6 1525590489054 7 No atRiskChlorthalidoneAmlodipineLisinopril 1447785768535 1382082188123 1310278437711 1136268246662 634038703832 295618781770 209215195 Chlorthalidone Amlodipine Lisinopril www hypertensiononline org ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation 0 5 1 2 0 5 1 2 ALLHATCHDDeathandNonfatalMI www hypertensiononline org Favorslisinopril Favorschlorthalidone Favorsamlodipine Favorschlorthalidone ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation 0 5 1 2 0 5 2 ALLHATAll CauseMortality www hypertensiononline org Favorslisinopril Favorschlorthalidone Favorsamlodipine Favorschlorthalidone 1 ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation 0 5 2 0 5 2 ALLHATCombinedCVDisease www hypertensiononline org Favorsamlodipine Favorschlorthalidone Favorslisinopril Favorschlorthalidone 1 1 ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation ALLHATStrokebyTreatmentGroup 0 1 2 3 4 5 6 1525590489054 7 No atRiskChlorthalidoneAmlodipineLisinopril 1451586178543 1393482718172 1330979497784 1157069376765 638538453891 321718131828 567506949 Cumulativeeventrate Chlorthalidone Amlodipine Lisinopril Timetoevent yrs www hypertensiononline org ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation 0 5 1 2 0 5 2 ALLHATStroke www hypertensiononline org Favorsamlodipine Favorschlorthalidone Favorslisinopril Favorschlorthalidone 1 ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation ALLHATHeartFailurebyTreatmentGroup 0 1 2 3 4 5 6 1525590489054 7 No atRiskChlorthalidoneAmlodipineLisinopril 1452885358496 1389881858096 1322478017689 1151167856698 636937753789 301617801837 384210313 Cumulativeeventrate Chlorthalidone Amlodipine Lisinopril Timetoevent yrs www hypertensiononline org P 0 001forchlorthalidonevsamlodipineandchlorthalidonevslisinopril ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation 0 5 2 0 5 2 ALLHATHeartFailure www hypertensiononline org Favorsamlodipine Favorschlorthalidone Favorslisinopril Favorschlorthalidone 1 1 ALLHATResearchGroup JAMA 2002 288 2981 2997 Copyright 2002 AmericanMedicalAssociation ALLHATConclusions BettercontrolofsystolicBPwasachievedwithchlorthalidonethanwithamlodipineorlisinoprilTherewerenodifferencesinriskforCHDdeath nonfatalMIbetweenchlorthalidoneandamlodipineorlisinoprilInsecondaryendpoints chlorthalidonewasassociatedwithlowerriskfo