在抗高血压和降脂治疗预防心脏病发作试验（ALLHAT）中，使用三种不同抗高血压药物治疗的正常体重、超重和肥胖高血压患者的血压控制及心血管结局
Blood pressure control and cardiovascular outcomes in normal-weight, overweight, and obese hypertensive patients treated with three different antihypertensives in ALLHAT.
作者信息
Reisin Efrain, Graves John W, Yamal José-Miguel, Barzilay Joshua I, Pressel Sara L, Einhorn Paula T, Dart Richard A, Retta Tamrat M, Saklayen Mohammad G, Davis Barry R
机构信息
aSection of Nephrology and Hypertension, Louisiana State University Health Science Center, New Orleans, Louisiana bDivision of Nephrology/Hypertension, Mayo Clinic, Rochester, Minnesota cCoordinating Center for Clinical Trials, The University of Texas School of Public Health, Houston, Texas dDivision of Endocrinology, Kaiser Permanente of Georgia and Emory University School of Medicine, Atlanta, Georgia eThe National Heart, Lung, and Blood Institute, Bethesda, Maryland fCenter for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, Wisconsin gHoward University Hypertension and Lipid Clinic, Howard University Hospital, Washington, District of Columbia hVeterans Affairs Medical Center and Wright State University Veterans Affairs Campus, Dayton, Ohio, USA.
出版信息
J Hypertens. 2014 Jul;32(7):1503-13; discussion 1513. doi: 10.1097/HJH.0000000000000204.
OBJECTIVE
Epidemiologically, there is a strong relationship between BMI and blood pressure (BP) levels. We prospectively examined randomization to first-step chlorthalidone, a thiazide-type diuretic; amlodipine, a calcium-channel blocker; and lisinopril, an angiotensin-converting enzyme inhibitor, on BP control and cardiovascular outcomes in a hypertensive cohort stratified by baseline BMI [kg/m(2); normal weight (BMI <25), overweight (BMI = 25-29.9), and obese (BMI >30)].
METHODS
In a randomized, double-blind, practice-based Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, 33,357 hypertensive participants, aged at least 55 years, were followed for an average of 4.9 years, for a primary outcome of fatal coronary heart disease or nonfatal myocardial infarction, and secondary outcomes of stroke, heart failure, combined cardiovascular disease, mortality, and renal failure.
RESULTS
Of participants, 37.9% were overweight and 42.1% were obese at randomization. For each medication, BP control (<140/90 mmHg) was equivalent in each BMI stratum. At the fifth year, 66.1, 66.5, and 65.1% of normal-weight, overweight, and obese participants, respectively, were controlled. Those randomized to chlorthalidone had highest BP control (67.2, 68.3, and 68.4%, respectively) and to lisinopril the lowest (60.4, 63.2, and 59.6%, respectively) in each BMI stratum. A significant interaction (P = 0.004) suggests a lower coronary heart disease risk in the obese for lisinopril versus chlorthalidone (hazard ratio 0.85, 95% confidence interval 0.74-0.98) and a significant interaction (P = 0.011) suggests a higher risk of end-stage renal disease for amlodipine versus chlorthalidone in obese participants (hazard ratio 1.49, 95% confidence interval 1.06-2.08). However, these results were not consistent among other outcomes.
CONCLUSION
BMI status does not modify the effects of antihypertensive medications on BP control or cardiovascular disease outcomes.
目的
从流行病学角度来看，体重指数（BMI）与血压（BP）水平之间存在密切关系。我们前瞻性地研究了在按基线BMI[kg/m²；正常体重（BMI<25）、超重（BMI=25-29.9）和肥胖（BMI>30）]分层的高血压队列中，随机接受第一步治疗的氯噻酮（一种噻嗪类利尿剂）、氨氯地平（一种钙通道阻滞剂）和赖诺普利（一种血管紧张素转换酶抑制剂）对血压控制和心血管结局的影响。
方法
在一项基于实践的随机、双盲、抗高血压和降脂治疗预防心脏病发作试验中，对33357名年龄至少55岁的高血压参与者进行了平均4.9年的随访，主要结局为致命性冠心病或非致命性心肌梗死，次要结局为中风、心力衰竭、合并心血管疾病、死亡率和肾衰竭。
结果
在随机分组时，37.9%的参与者超重，42.1%的参与者肥胖。对于每种药物，在每个BMI分层中血压控制（<140/90 mmHg）相当。在第五年，正常体重、超重和肥胖参与者的血压控制率分别为66.1%、66.5%和65.1%。在每个BMI分层中，随机接受氯噻酮治疗的参与者血压控制率最高（分别为67.2%、68.3%和68.4%），而随机接受赖诺普利治疗的参与者血压控制率最低（分别为60.4%、63.2%和59.6%）。显著的交互作用（P=0.004）表明，与氯噻酮相比，肥胖者使用赖诺普利患冠心病的风险较低（风险比0.85，95%置信区间0.74-0.98），显著的交互作用（P=0.011）表明，在肥胖参与者中，与氯噻酮相比，氨氯地平导致终末期肾病的风险较高（风险比1.49，95%置信区间1.06-2.08）。然而，这些结果在其他结局中并不一致。
结论
BMI状态不会改变抗高血压药物对血压控制或心血管疾病结局的影响。
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