Muntner Paul, Levitan Emily B, Lynch Amy I, Simpson Lara M, Whittle Jeffrey, Davis Barry R, Kostis John B, Whelton Paul K, Oparil Suzanne
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
J Clin Hypertens (Greenwich). 2014 May;16(5):323-30. doi: 10.1111/jch.12290. Epub 2014 Apr 16.
Few randomized trials have compared visit-to-visit variability (VVV) of systolic blood pressure (SBP) across drug classes. The authors compared VVV of SBP among 24,004 participants randomized to chlorthalidone, amlodipine, or lisinopril in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of SBP was calculated across 5 to 7 visits occurring 6 to 28 months following randomization. The standard deviation (SD) of SBP was 10.6 (SD=5.0), 10.5 (SD=4.9), and 12.2 (SD=5.8) for participants randomized to chlorthalidone, amlodipine, and lisinopril, respectively. After multivariable adjustment including mean SBP across visits and compared with participants randomized to chlorthalidone, participants randomized to amlodipine had a 0.36 (standard error [SE]: 0.07) lower SD of SBP and participants randomized to lisinopril had a 0.77 (SE=0.08) higher SD of SBP. Results were consistent using other VVV of SBP metrics. These data suggest chlorthalidone and amlodipine are associated with lower VVV of SBP than lisinopril.
很少有随机试验比较过不同药物类别之间收缩压（SBP）的逐次就诊变异性（VVV）。作者在“降压和降脂治疗预防心脏病发作试验”（ALLHAT）中，比较了随机分配接受氯噻酮、氨氯地平或赖诺普利治疗的24004名参与者的SBP的VVV。SBP的VVV是在随机分组后6至28个月内进行的5至7次就诊时计算得出的。随机分配接受氯噻酮、氨氯地平或赖诺普利治疗的参与者，其SBP的标准差（SD）分别为10.6（SD = 5.0）、10.5（SD = 4.9）和12.2（SD = 5.8）。在进行包括各次就诊平均SBP在内的多变量调整后，与随机分配接受氯噻酮治疗的参与者相比，随机分配接受氨氯地平治疗的参与者SBP的SD低0.36（标准误[SE]：0.07），而随机分配接受赖诺普利治疗的参与者SBP的SD高0.77（SE = 0.08）。使用其他SBP的VVV指标时，结果一致。这些数据表明，与赖诺普利相比，氯噻酮和氨氯地平与较低的SBP的VVV相关。
