Metabolic and Clinical Outcomes in Nondiabetic Individuals With the Metabolic Syndrome Assigned to Chlorthalidone, Amlodipine, or Lisinopril as Initial Treatment for Hypertension A report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

被引：85

作者：

Black, Henry R. ^{[2
]}

Davis, Barry ^{[3
]}

Barzilay, Joshua ^{[1
]}

Nwachuku, Chuke ^{[4
]}

Baimbridge, Charles ^{[3
]}

Marginean, Horia ^{[5
]}

Wright, Jackson T., Jr. ^{[6
]}

Basile, Jan ^{[7
]}

Wong, Nathan D. ^{[8
]}

Whelton, Paul ^{[9
]}

Dart, Richard A. ^{[10
]}

Thadani, Udho ^{[11
]}

机构：

[1] Kaiser Permanente Georgia, Tucker, GA 30084 USA

[2] NYU, Sch Med, New York, NY USA

[3] Univ Texas Hlth Sci Ctr Houston, Sch Publ Hlth, Houston, TX USA

[4] NHLBI, Bethesda, MD 20892 USA

[5] Ottawa Hosp, Ottawa, ON, Canada

[6] Univ Hosp Cleveland, Gen Clin Res Ctr, Cleveland, OH 44106 USA

[7] VA Med Ctr Charleston, Charleston, SC USA

[8] Univ So Calif, Med Ctr, Los Angeles, CA USA

[9] Loyola Univ, Sch Med, Maywood, IL 60153 USA

[10] Marshfield Clin Fdn Med Res & Educ, Marshfield, WI USA

[11] Univ Oklahoma, Hlth Sci Ctr, VA Med Ctr, Oklahoma City, OK USA

来源：

DIABETES CARE | 2008年 / 31卷 / 02期

关键词：

D O I：

10.2337/dc07-1452

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE - Optimal initial anti hypertensive drug therapy in people with the metabolic syndrome is unknown. RESEARCH DESIGN AND METHODS - We conducted a subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to compare metabolic, cardiovascular, and renal outcomes in individuals assigned to initial hypertension treatment with a thiazide-like diuretic (chlorthalidone), a calcium channel blocker (CCB; amlodipine), or an ACE inhibitor (lisinopril) in nondiabetic individuals with or without metabolic syndrome. RESULTS - in participants with metabolic syndrome, at 4 years of follow-up, the incidence of newly diagnosed diabetes (fasting glucose >= 126 mg/dl) was 17.1% for chlorthalidone, 16.0% for amlodipine (P = 0.49, chlorthalidone vs. amlodipine) and 12.6% for lisinopril (P < 0.05, lisinopril vs. chlorthalidone). For those without metabolic syndrome, the rate of newly diagnosed diabetes was 7.7% for chlorthalidone, 4.2% for amlodipine, and 4.7% for lisinopril (P < 0.05 for both comparisons). There were no differences in relative risks (RRs) for outcomes With amlodipine compared with chlorthalidone in those with metabolic syndromes in those without metabolic syndrome, there was a higher risk for heart failure (RR 1.55 [95% CI 1.25-1.35]), In comparison With lisinopril, chlorthalidone was superior in those with Metabolic syndrome with respect to heart failure (1.31 [1.04-1.64]) and combined cardiovascular, disease (CVD) (1.19 - 1.07-1.32]). No significant treatment group-metabolic syndrome interaction was noted. CONCLUSIONS - Despite a less favor thiazide-like diuretic able Metabolic profile, initial therapy for hypertension offers similar, and in some instances possibly superior, CVD outcomes in older hypertensive adults with metabolic syndrome, as compared with treatment With CCBs and ACE inhibitors.

引用

页码：353 / 360

页数：8

共 30 条

[1] Diuretic versus α-blocker as first-step antihypertensive therapy -: Final results from the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT) [J].