在基线估计肾小球滤过率的情况下，抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）参与者的长期肾脏和心血管结局。
Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR.
机构信息
Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, USA.
出版信息
Clin J Am Soc Nephrol. 2012 Jun;7(6):989-1002. doi: 10.2215/CJN.07800811. Epub 2012 Apr 5.
BACKGROUND AND OBJECTIVES
CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with chlorthalidone.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged ≥55 years, randomized to receive chlorthalidone, amlodipine, or lisinopril for 4-8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m(2)) as follows: normal/increased (≥90; n=8027), mild reduction (60-89; n=17,778), and moderate/severe reduction (<60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD.
RESULTS
After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P<0.001). In participants with an eGFR <60, there was no significant difference in cardiovascular mortality between chlorthalidone and amlodipine (P=0.64), or chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD.
CONCLUSIONS
CKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up. Because data on proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.
背景和目的
CKD 在老年患者中很常见。本文评估了基线估计肾小球滤过率（eGFR）分层的老年高危高血压患者的长期肾脏和心血管结局，并评估了氨氯地平或赖诺普利与氯噻酮相比，5 年起始治疗的长期疗效。
设计、地点、参与者和测量：这是一项对高血压参与者（n=31350，年龄≥55 岁）的长期临床试验随访，这些参与者随机接受氯噻酮、氨氯地平或赖诺普利治疗 4-8 年，在 593 个中心进行。根据基线 eGFR（ml/min/1.73m2）将参与者分层如下：正常/增加（≥90；n=8027）、轻度降低（60-89；n=17778）和中度/重度降低（<60；n=5545）。结局为心血管死亡率（主要结局）、总死亡率、冠心病、心血管疾病、卒中和心力衰竭以及终末期肾病。
结果
平均 8.8 年的随访后，eGFR 中度/重度降低的参与者总死亡率明显高于 eGFR 正常和轻度降低的参与者（P<0.001）。在 eGFR<60 的参与者中，氯噻酮与氨氯地平（P=0.64）或氯噻酮与赖诺普利（P=0.56）之间心血管死亡率无显著差异。同样，总死亡率、冠心病、心血管疾病、卒中和终末期肾病也无显著差异。
结论
CKD 与老年高血压患者长期发生心血管事件和死亡的风险显著增加相关。根据 eGFR 分层，5 年氨氯地平或赖诺普利治疗与氯噻酮相比，在 9 年随访期间不能预防心血管事件、死亡率或终末期肾病。由于蛋白尿数据不可用，这些发现可能不适用于蛋白尿性 CKD。
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