Newer antihypertensive therapy reduces cardiovascular events
http://www.100md.com
《英国医生杂志》
Antihypertensive therapy based on the calcium channel blocker amlodipine, with the angiotensin converting enzyme inhibitor perindopril added as required, reduced cardiovascular events compared with treatment based on the blocker atenolol, according to the final results from the Anglo-Scandinavian cardiac out-comes trial-blood pressure lowering arm (ASCOT-BPLA) trial published online this week in the Lancet (www.lancet.com, doi:10.1016/S0140-6736(05)67186-3).
The trial randomised 19 257 hypertensive patients aged 40-79 years with at least three other cardiovascular risk factors to one of two antihypertensive regimens—amlodipine (5-10 mg) with or without perindopril (4-8 mg), or atenolol (50-100 mg) with or without the thiazide diuretic bendroflumethiazide (1.25-2.5 mg). Additional antihypertensives could be added to achieve a target blood pressure of at most 140/90 mm Hg.
The blood pressure lowering trial was stopped prematurely after a median follow-up of 5.5 years on the recommendation of the trial's data and safety monitoring board after they observed a significant advantage in favour of patients taking amlodipine based treatment.
The final results reported this week at the European Society of Cardiology's annual congress showed a 10% reduction in the primary end point of non-fatal myocardial infarction or fatal coronary heart disease with amlodipine based therapy. This did not reach statistical significance, which the investigators attributed to the study being stopped early, but showed that fewer individuals on the amlodipine based regimen had a non-fatal myocardial infarction or fatal coronary heart disease compared with atenolol based treatment (429 v 474; unadjusted hazard ratio 0.90, 95% confidence interval 0.79 to 1.02, P=0.1052).
Further results showed that patients treated with the amlodipine based regimen had significantly lower rates of fatal and non-fatal stroke (327 v 422; 0.77, 0.66 to 0.89, P=0.0003), total cardiovascular events and procedures (1362 v 1602; 0.84, 0.78 to 0.90, P<0.0001), and death from any cause (738 v 820; 0.89, 0.81 to 0.99, P=0.025). The incidence of developing diabetes was lower on the amlodipine based regimen (567 v 799; 0.70, 0.63 to 0.78, P<0.0001) and new onset renal dysfunction was reduced by 15% (P=0.02).
One of the study's authors, Neil Poulter, professor of preventive cardiovascular medicine, Imperial College, London, and president of the British Hypertension Society, considered that the findings were likely to change the management of hypertension and influence guidelines. " blockers will no longer be the first choice in uncomplicated hypertension. I think inhibitors will probably be recommended first line for younger patients and calcium channel blockers or diuretics for older patients." He noted that that the British Hypertension Society is meeting with the National Institute for Health and Clinical Excellence (whose guideline currently recommends initial treatment of hypertension with a diuretic, followed by a blocker for patients not at risk of diabetes) later this month with the hope of developing a shared set of guidelines for the United Kingdom.(Susan Mayor)
The trial randomised 19 257 hypertensive patients aged 40-79 years with at least three other cardiovascular risk factors to one of two antihypertensive regimens—amlodipine (5-10 mg) with or without perindopril (4-8 mg), or atenolol (50-100 mg) with or without the thiazide diuretic bendroflumethiazide (1.25-2.5 mg). Additional antihypertensives could be added to achieve a target blood pressure of at most 140/90 mm Hg.
The blood pressure lowering trial was stopped prematurely after a median follow-up of 5.5 years on the recommendation of the trial's data and safety monitoring board after they observed a significant advantage in favour of patients taking amlodipine based treatment.
The final results reported this week at the European Society of Cardiology's annual congress showed a 10% reduction in the primary end point of non-fatal myocardial infarction or fatal coronary heart disease with amlodipine based therapy. This did not reach statistical significance, which the investigators attributed to the study being stopped early, but showed that fewer individuals on the amlodipine based regimen had a non-fatal myocardial infarction or fatal coronary heart disease compared with atenolol based treatment (429 v 474; unadjusted hazard ratio 0.90, 95% confidence interval 0.79 to 1.02, P=0.1052).
Further results showed that patients treated with the amlodipine based regimen had significantly lower rates of fatal and non-fatal stroke (327 v 422; 0.77, 0.66 to 0.89, P=0.0003), total cardiovascular events and procedures (1362 v 1602; 0.84, 0.78 to 0.90, P<0.0001), and death from any cause (738 v 820; 0.89, 0.81 to 0.99, P=0.025). The incidence of developing diabetes was lower on the amlodipine based regimen (567 v 799; 0.70, 0.63 to 0.78, P<0.0001) and new onset renal dysfunction was reduced by 15% (P=0.02).
One of the study's authors, Neil Poulter, professor of preventive cardiovascular medicine, Imperial College, London, and president of the British Hypertension Society, considered that the findings were likely to change the management of hypertension and influence guidelines. " blockers will no longer be the first choice in uncomplicated hypertension. I think inhibitors will probably be recommended first line for younger patients and calcium channel blockers or diuretics for older patients." He noted that that the British Hypertension Society is meeting with the National Institute for Health and Clinical Excellence (whose guideline currently recommends initial treatment of hypertension with a diuretic, followed by a blocker for patients not at risk of diabetes) later this month with the hope of developing a shared set of guidelines for the United Kingdom.(Susan Mayor)