Petitti Diana B, Xie Fagen, Barzilay Joshua I
Kaiser Permanente Southern California, 393 E. Walnut Street, Pasadena, 91188, USA.
Contemp Clin Trials. 2006 Oct;27(5):397-403. doi: 10.1016/j.cct.2006.04.010.
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) published its main findings in December, 2002. It recommended thiazide diuretics as a first-line treatment of hypertension. The current study describes the prescribing patterns of thiazide diuretics in four regions of Kaiser Permanente, a large national United States Health Maintenance Organization--two regions that had an ALLHAT clinical center and two that did not. We tested the hypothesis that participation in a clinical trial leads to quicker and greater adoption of study recommendations than non-participation in a trial. The relative percentage of filled outpatient prescriptions for the period 2 or 3 years before the ALLHAT main publication through December 31, 2004 was calculated by region for thiazide-type diuretics and for calcium channel blockers (CCBs), beta-blockers, central alpha-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and other antihypertensive diuretics. In the 2 years after publication of the ALLHAT trial findings, the percentage of all prescriptions for thiazide diuretics increased from 11.2% to 12.4% in the two regions with an ALLHAT clinical site and from 8.9% to 10.1% in the two regions without an ALLHAT clinical site (p > 0.05). The percentage of new prescriptions for thiazide diuretics increased from 13.7% to 16.6% in the two regions with an ALLHAT clinical site and from 10.8% to 13.0% in the two regions without an ALLHAT clinical site (p > 0.05). Participation in a clinical hypertension study does not appear to accelerate adoption of study recommendations.
抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）于2002年12月公布了其主要研究结果。该试验推荐噻嗪类利尿剂作为高血压的一线治疗药物。本研究描述了美国一家大型全国性健康维护组织凯泽医疗集团四个地区噻嗪类利尿剂的处方模式，其中两个地区设有ALLHAT临床中心，另外两个地区没有。我们检验了这样一个假设，即参与临床试验比不参与临床试验能更快、更广泛地采用研究推荐。通过计算噻嗪类利尿剂、钙通道阻滞剂（CCB）、β受体阻滞剂、中枢α受体阻滞剂、血管紧张素转换酶（ACE）抑制剂、血管紧张素受体阻滞剂（ARB）以及其他抗高血压利尿剂在ALLHAT主要研究结果公布前两到三年直至2004年12月31日期间各地区门诊处方的相对占比。在ALLHAT试验结果公布后的两年里，设有ALLHAT临床中心的两个地区中，噻嗪类利尿剂在所有处方中的占比从11.2%增至12.4%，而没有ALLHAT临床中心的两个地区该占比则从8.9%增至10.1%（p>0.05）。设有ALLHAT临床中心的两个地区中，噻嗪类利尿剂新处方的占比从13.7%增至16.6%，没有ALLHAT临床中心的两个地区该占比从10.8%增至13.0%（p>0.05）。参与临床高血压研究似乎并未加速对研究推荐的采用。
