National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
Curr Opin Cardiol. 2010 Jul;25(4):355-65. doi: 10.1097/HCO.0b013e32833a8828.
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is re-evaluated considering information from recent subgroup and exploratory analyses, other new clinical trials, and meta-analyses. The ALLHAT analyses specifically emphasize heart failure findings, results in Black participants and those with chronic kidney disease, selection and doses of thiazide and similar diuretics, and the association of antihypertensive drug use with new-onset diabetes and its cardiovascular consequences.
The initial ALLHAT conclusion, that thiazide diuretics are superior to angiotensin-converting enzyme inhibitors (ACEIs), calcium antagonists (CCBs) and alpha-blockers in preventing one or more major clinical outcomes, including heart failure and stroke, and unsurpassed in significantly preventing any cardiovascular or renal outcome, has been further validated for patients with diabetes, renal disease, and/or metabolic syndrome. The evidence is even more compelling for Black patients. New-onset diabetes associated with thiazides did not increase cardiovascular outcomes. The diuretic was superior to all in preventing heart failure with preserved left-ventricular ejection fraction (LVEF) and similar to the ACEI in preventing heart failure with impaired LVEF. It was also unsurpassed in preventing atrial fibrillation.
The totality of evidence re-affirms the initial ALLHAT conclusion that thiazide and similar diuretics (at evidence-based doses) are the preferred first-step therapy in most patients with hypertension.
抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）重新评估了近期亚组和探索性分析、其他新临床试验和荟萃分析的信息。ALLHAT 分析特别强调心力衰竭的发现、黑人和慢性肾脏病患者的结果、噻嗪类和类似利尿剂的选择和剂量，以及抗高血压药物的使用与新发糖尿病及其心血管后果之间的关系。
噻嗪类利尿剂在预防一个或多个主要临床结局（包括心力衰竭和中风）方面优于血管紧张素转换酶抑制剂（ACEI）、钙拮抗剂（CCB）和α受体阻滞剂，并且在显著预防任何心血管或肾脏结局方面无与伦比，这一最初的 ALLHAT 结论已经得到了进一步验证，适用于糖尿病、肾脏疾病和/或代谢综合征患者。对于黑人患者来说，证据更加有力。噻嗪类药物引起的新发糖尿病并未增加心血管结局。与其他药物相比，该利尿剂在预防左心室射血分数（LVEF）正常的心力衰竭方面更具优势，与 ACEI 预防 LVEF 降低的心力衰竭相似。它在预防心房颤动方面也无与伦比。
所有证据都再次证实了最初的 ALLHAT 结论，即噻嗪类和类似利尿剂（基于证据的剂量）是大多数高血压患者首选的一线治疗药物。
