Old drugs for heart failure nearly halve deaths in black people
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《英国医生杂志》
Adding a dose of isosorbide dinitrate plus hydralazine to standard treatment for advanced heart failure can help black people live longer, shows a study. However, adding an angiotensin converting enzyme (ACE) inhibitor to the optimal treatment of stable heart disease offers no extra benefits.
Findings from two new studies were published this week to coincide with the annual meeting of the American Heart Association in New Orleans.
Researchers in the first study terminated their study early when they found that black people with advanced heart failure treated with a fixed dose of isosorbide dinitrate plus hydralazine were 43% less likely to die than those who received isosorbide dinitrate plus placebo (hazard ratio 0.57, P<0.0001, death rate 6.2% v 10.2%, P=0.02) ( New England Journal of Medicine 2004;351: 2049-57).
All of the 1050 black patients in the study (who had New York Heart Association class III or IV heart failure with dilated ventricles) were receiving standard treatment for heart failure. They were then randomly assigned to receive a fixed dose of isosorbide dinitrate plus either hydralazine or placebo.
Improved survival was accompanied by a 33% relative reduction in the rate of first admission to hospital for heart failure (16.4% v 22.4%, P=0.001) and an improvement in the quality of life among patients on active treatment.
In the second study (the prevention of the events with angiotensin converting enzyme inhibition (PEACE) trial) the researchers found that patients with stable coronary heart disease and preserved left ventricular function who are receiving standard therapy that typically included a daily aspirin (90% of patients), a statin (70%), and a blocker (60%) received no incremental benefit from the addition of an ACE inhibitor to their regimen ( New England Journal of Medicine 2004;351: 2058-68).
The PEACE trial was a double blind, placebo controlled study in which 8290 patients were randomly assigned to receive either trandolapril at a target dose of 4 mg a day (4158 patients) or matching placebo (4132 patients).
Over a median follow up period of 4.8 years, the incidence of the primary end point—death from cardiovascular causes, myocardial infarction, or coronary revascularisation—was 21.9% in the group taking trandolapril, compared with 22.5% in the placebo group (hazard ratio in the trandolapril group, 0.96; 95% confidence interval, 0.88 to 1.06; P=0.43).(Scott Gottlieb)
Findings from two new studies were published this week to coincide with the annual meeting of the American Heart Association in New Orleans.
Researchers in the first study terminated their study early when they found that black people with advanced heart failure treated with a fixed dose of isosorbide dinitrate plus hydralazine were 43% less likely to die than those who received isosorbide dinitrate plus placebo (hazard ratio 0.57, P<0.0001, death rate 6.2% v 10.2%, P=0.02) ( New England Journal of Medicine 2004;351: 2049-57).
All of the 1050 black patients in the study (who had New York Heart Association class III or IV heart failure with dilated ventricles) were receiving standard treatment for heart failure. They were then randomly assigned to receive a fixed dose of isosorbide dinitrate plus either hydralazine or placebo.
Improved survival was accompanied by a 33% relative reduction in the rate of first admission to hospital for heart failure (16.4% v 22.4%, P=0.001) and an improvement in the quality of life among patients on active treatment.
In the second study (the prevention of the events with angiotensin converting enzyme inhibition (PEACE) trial) the researchers found that patients with stable coronary heart disease and preserved left ventricular function who are receiving standard therapy that typically included a daily aspirin (90% of patients), a statin (70%), and a blocker (60%) received no incremental benefit from the addition of an ACE inhibitor to their regimen ( New England Journal of Medicine 2004;351: 2058-68).
The PEACE trial was a double blind, placebo controlled study in which 8290 patients were randomly assigned to receive either trandolapril at a target dose of 4 mg a day (4158 patients) or matching placebo (4132 patients).
Over a median follow up period of 4.8 years, the incidence of the primary end point—death from cardiovascular causes, myocardial infarction, or coronary revascularisation—was 21.9% in the group taking trandolapril, compared with 22.5% in the placebo group (hazard ratio in the trandolapril group, 0.96; 95% confidence interval, 0.88 to 1.06; P=0.43).(Scott Gottlieb)