Zanchetti A
Centro di Fisiologia Clinica e Ipertensione and Istituto di Clinica Medica, University of Milan and Ospedale Maggiore and Istituto Auxologico Italiano, Italy.
Am J Hypertens. 1997 Oct;10(10 Pt 2):223S-229S. doi: 10.1016/s0895-7061(97)00327-0.
Multiple risk factors for cardiovascular disease, particularly hypercholesterolemia, are often present in the hypertensive patient. Recent guidelines, ranging from those prepared by the World Health Organization/International Society of Hypertension to those of the three European Societies of Cardiology, Atherosclerosis, and Hypertension, stress the importance of evaluating global risk, based on the presence of all cardiovascular risk factors in an individual or in a group of subjects. It has also been suggested that treatment should aim to correct all modifiable risk factors. This is a reasonable recommendation, but although observational epidemiologic studies have shown that the effects of concomitant risk factors are additive, if not multiplicative, it is surprising that no intervention trial has been undertaken to determine whether the benefits of treating more than one risk factor are also additive. The Plaque Hypertension Lipid-Lowering Italian Study (PHYLLIS) is the first such study. Its aim is to investigate the potential benefit of lowering blood pressure and plasma cholesterol on the progression of carotid plaque in hypertensive patients with elevated plasma cholesterol. Using a factorial design, the antiatherosclerotic effect of two different antihypertensive drugs, the angiotensin-converting enzyme (ACE) inhibitor fosinopril and the diuretic hydrochlorothiazide will be compared. The study aims to confirm animal experiments demonstrating the benefit of ACE inhibitors on experimental atherosclerosis. PHYLLIS will also compare the effects of two lipid-lowering regimens, diet plus placebo and diet plus pravastatin, in the study population. This 3-year, multicenter, double-blind, randomized Italian study, using B-mode ultrasound evaluation of the carotid walls with central reading of the ultrasound scans (Bowman Gray University, Winston-Salem, NC) is now underway and should provide useful evidence about the benefits of multiple risk factor treatment in the hypertensive patient.
高血压患者常常存在多种心血管疾病危险因素，尤其是高胆固醇血症。从世界卫生组织/国际高血压学会制定的指南到欧洲心脏病学、动脉粥样硬化和高血压三个学会的指南，近期的指南都强调基于个体或一组受试者中所有心血管危险因素来评估总体风险的重要性。也有人提出治疗应旨在纠正所有可改变的危险因素。这是一个合理的建议，但是尽管观察性流行病学研究表明伴随危险因素的作用是相加的（即便不是相乘的），然而令人惊讶的是，尚未进行干预试验来确定治疗多种危险因素的益处是否也是相加的。意大利斑块高血压降脂研究（PHYLLIS）就是首个此类研究。其目的是调查降低血压和血浆胆固醇对血浆胆固醇升高的高血压患者颈动脉斑块进展的潜在益处。采用析因设计，将比较两种不同降压药物（血管紧张素转换酶（ACE）抑制剂福辛普利和利尿剂氢氯噻嗪）的抗动脉粥样硬化作用。该研究旨在证实动物实验所表明的ACE抑制剂对实验性动脉粥样硬化的益处。PHYLLIS还将在研究人群中比较两种降脂方案（饮食加安慰剂和饮食加普伐他汀）的效果。这项为期3年的多中心、双盲、随机意大利研究，采用B型超声评估颈动脉壁并由中央机构（北卡罗来纳州温斯顿 - 塞勒姆的鲍曼格雷大学）对超声扫描进行解读，目前正在进行中，应该会为高血压患者多种危险因素治疗的益处提供有用的证据。
