Mancia G, Grassi G
Cattedra di Medicina Interna, Università di Milano, Ospedale S. Gerardo, Monza, Italy.
Am J Cardiol. 1998 Nov 12;82(9B):23R-28R. doi: 10.1016/s0002-9149(98)00753-x.
Several trials have shown that antihypertensive drug treatment decreases cardiovascular morbidity and mortality rates. They have also shown, however, that the risk is not decreased to the level of nonhypertensive patients. Trials are therefore underway to determine whether the benefits achieved by older drugs, such as diuretics and beta blockers, can be enhanced by using newer classes of antihypertensive agents, such as calcium antagonists, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor antagonists. Among these trials, the International Nifedipine GITS Study of Intervention as a Goal in Hypertension Treatment (INSIGHT) is of special interest because it is the first study to address, in a prospective fashion, the prognostic influence of antihypertensive treatment (nifedipine GITS vs a combined thiazide and potassium-sparing diuretic) in hypertensive patients with concomitant risk factors such as hypercholesterolemia, cigarette smoking, diabetes, and left ventricular hypertrophy. This article briefly describes the rationale and design of the INSIGHT trial and cites the substudies and the preliminary data available.
多项试验表明，抗高血压药物治疗可降低心血管疾病的发病率和死亡率。然而，这些试验也表明，风险并未降至非高血压患者的水平。因此，目前正在进行试验，以确定使用新型抗高血压药物（如钙拮抗剂、血管紧张素转换酶（ACE）抑制剂和血管紧张素II受体拮抗剂）是否可以增强利尿剂和β受体阻滞剂等老药所带来的益处。在这些试验中，国际硝苯地平控释片高血压治疗干预目标研究（INSIGHT）特别引人关注，因为它是第一项以前瞻性方式探讨抗高血压治疗（硝苯地平控释片与噻嗪类和保钾利尿剂联合使用）对伴有高胆固醇血症、吸烟、糖尿病和左心室肥厚等危险因素的高血压患者预后影响的研究。本文简要介绍了INSIGHT试验的基本原理和设计，并引用了子研究和现有的初步数据。
