【medical-news】长期数据显示： 昂贵的新型高血压药疗效未优于普通同类药

Expensive New Blood Pressure Meds No Better Than Generics, According to Long-Term Data


ScienceDaily (Aug. 14, 2010) — Expensive brand-name medications to lower blood pressure are no better at preventing cardiovascular disease than older, generic diuretics, according to new long-term data from a landmark study.

Paul Whelton, MB, MD, MSc, reported the results on Aug. 13 at the plenary session of the China Heart Congress and International Heart Forum in Beijing. Whelton is president and CEO of Loyola University Health System and chairman of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heat Attack Trial (ALLHAT), which has examined the comparative value of different blood pressure-lowering medications.

More than 33,000 patients with high blood pressure were randomly assigned to take either a diuretic (chlorthalidone) or one of two newer drugs, a calcium channel blocker (amlodipine) or an ACE inhibitor (lisinopril).

In 2002, ALLHAT researchers reported that among patients followed for four-to-eight years, the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and overall cardiovascular disease.

In the new study, researchers followed ALLHAT participants for an additional four to five years after completion of the trial, bringing the total follow-up period to between eight and 13 years. During this longer follow-up period, the differences between the three drugs narrowed -- by most measures they were a statistical dead heat.

But the diuretic still was superior in two measures: Compared with the diuretic group, the ACE inhibitor group had a 20 percent higher death rate from stroke, and the calcium channel blocker group had a 12 percent higher rate of hospitalizations and deaths due to heart failure.

Diuretics, sometimes called "water pills," are the traditional medications for high blood pressure. They cause kidneys to remove sodium and water from the body, thereby relaxing blood vessel walls. ACE inhibitors such as lisinopril (brand names, Prinivil® and Zestril®) decrease chemicals that tighten blood vessels. Calcium channel blockers such as amlodipine (brand name, Norvasc®) relax blood vessels.

Diuretics cost $25 to $40 per year, while newer brand-name hypertension drugs can cost $300 to $600 per year.

The National Heart, Lung and Blood Institute recommends patients control their blood pressure by first controlling their weight, exercising, reducing sodium, increasing potassium and drinking alcohol in moderation. The institute says that if lifestyle changes are not sufficient, diuretics then normally should be the drug of first choice.

However, newer, higher-priced drugs are heavily marketed, and diuretics account for only about 30 percent of prescriptions written for high blood pressure medications, Whelton said.

Whelton is senior author of a study published in the May 24, 2010, Archives of Internal Medicine that found that using techniques similar to those employed by pharmaceutical sales reps can help persuade doctors to prescribe diuretics.

Like drug sales representatives, researchers in the study met with small groups of doctors, especially opinion leaders. They detailed guidelines for treating high blood pressure, and handed out studies, newsletters, exam room posters, etc. An examination of prescribing patterns found that this technique, known as "academic detailing," influenced what drugs doctors prescribed.

ALLHAT is sponsored by the National Heart, Lung and Blood Institute. "We are continuing to mine data that we collected during the trial," Whelton said.

http://www.sciencedaily.com/releases/2010/08/100813082715.htm
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Expensive New Blood Pressure Meds No Better Than Generics, According to Long-Term Data

长期数据显示： 昂贵的新型高血压药疗效未优于普通同类药



译者：Docofsoul



ScienceDaily (Aug. 14, 2010) — Expensive brand-name medications to lower blood pressure are no better at preventing cardiovascular disease than older, generic diuretics, according to new long-term data from a landmark study.

《每日科学》2010年8月14日报道 —— 根据一项里程碑式的研究所显示的新的长期数据： 价格昂贵的品牌降压药品在预防心血管疾病方面并不比一般性的老式利尿药品来得更好。

Paul Whelton, MB, MD, MSc, reported the results on Aug. 13 at the plenary session of the China Heart Congress and International Heart Forum in Beijing. Whelton is president and CEO of Loyola University Health System and chairman of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heat Attack Trial (ALLHAT), which has examined the comparative value of different blood pressure-lowering medications.

8月13日，医学学士、医学博士、理学硕士Paul Whelton在中国心脏大会暨北京国际心血管病论坛2010全体会议上报告了这一研究成果。Whelton是洛约拉大学健康系统（Loyola University Health System）的董事长与执行总裁、ALLHAT（Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial，应用抗高血压和降脂治疗预防心脏病发作研究）计划主席。ALLHAT计划业已检查了不同降压药品的比较值。

More than 33,000 patients with high blood pressure were randomly assigned to take either a diuretic (chlorthalidone) or one of two newer drugs, a calcium channel blocker (amlodipine) or an ACE inhibitor (lisinopril).

将超过33000名的高血压患者作随机分配，分配后的各组要么服用一种利尿降压药（氯噻酮），要么服用两种新型药品之一：钙拮抗剂（阿洛地平）或血管收缩转化酶抑制剂（赖诺普利）。

In 2002, ALLHAT researchers reported that among patients followed for four-to-eight years, the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and overall cardiovascular disease.

ALLHAT的研究者在2002年的报告中说，在随访时间为4到8年的患者中，在预防心力衰竭方面，利尿剂比钙拮抗剂好；而在预防中风、心衰与所有的心血管疾病方面，利尿剂比血管收缩转化酶抑制剂好。

In the new study, researchers followed ALLHAT participants for an additional four to five years after completion of the trial, bringing the total follow-up period to between eight and 13 years. During this longer follow-up period, the differences between the three drugs narrowed -- by most measures they were a statistical dead heat.

在这项新的研究中，研究者在试验完成后又对ALLHAT的参与者进行了额外的4到5年随访，这样总的随访时间达到8到13年。在此漫长的随访过程中，三种药物的差异缩小，即在大多数的指标上，其统计结果无差异。

But the diuretic still was superior in two measures: Compared with the diuretic group, the ACE inhibitor group had a 20 percent higher death rate from stroke, and the calcium channel blocker group had a 12 percent higher rate of hospitalizations and deaths due to heart failure.

但在两个指标方面，利尿剂却得以胜出：与利尿剂组相比，血管收缩转化酶抑制剂组中风死亡率提高了20%，而钙拮抗剂组由于心力衰竭，其住院与死亡率提高了12%。

Diuretics, sometimes called "water pills," are the traditional medications for high blood pressure. They cause kidneys to remove sodium and water from the body, thereby relaxing blood vessel walls. ACE inhibitors such as lisinopril (brand names, Prinivil® and Zestril®) decrease chemicals that tighten blood vessels. Calcium channel blockers such as amlodipine (brand name, Norvasc®) relax blood vessels.

利尿剂有时也称为“水泛丸”，是治疗高血压的传统药物，可使肾脏将钠与水从体内清除继而使血管壁松驰。而诸如赖诺普利（商品名：赖诺普利片剂< Prinivil®>或捷赐瑞< Zestril®>）等血管收缩转化酶抑制剂则可降低导致血管收缩的化学成份含量。阿诺地平（商品名：活络喜< Norvasc®>）之类的钙抑制剂则有松驰血管的功能。

Diuretics cost $25 to $40 per year, while newer brand-name hypertension drugs can cost $300 to $600 per year.

利尿剂一年需要患者付出25到40美元，而新型高血压药则每年需付出300到600美元。

The National Heart, Lung and Blood Institute recommends patients control their blood pressure by first controlling their weight, exercising, reducing sodium, increasing potassium and drinking alcohol in moderation. The institute says that if lifestyle changes are not sufficient, diuretics then normally should be the drug of first choice.


国家心肺血液研究所推荐：患者控制血压，首先应当控制其体重、锻炼身体、减少食盐摄入量（钠摄入量）、提高体内钾水平与适度喝酒。该研究所说，如果生活方式的变化尚不足以控制血压的话，那么利尿剂可作为药物降压的首选药品。


However, newer, higher-priced drugs are heavily marketed, and diuretics account for only about 30 percent of prescriptions written for high blood pressure medications, Whelton said.

但是Whelton指出，新型、高价药品在市场上呈狂轰滥炸之势，而利尿剂在治疗高血压的处方药品中所占比重仅30%。

Whelton is senior author of a study published in the May 24, 2010, Archives of Internal Medicine that found that using techniques similar to those employed by pharmaceutical sales reps can help persuade doctors to prescribe diuretics.
Like drug sales representatives, researchers in the study met with small groups of doctors, especially opinion leaders. They detailed guidelines for treating high blood pressure, and handed out studies, newsletters, exam room posters, etc. An examination of prescribing patterns found that this technique, known as "academic detailing," influenced what drugs doctors prescribed.

Whelton是在2010年5月24号《内科学文献》（《Archives of Internal Medicine》）上发表的一项研究论文的第一作者。他在论文中指出，运用类似于医药销售代表所采用的技巧可有助于说服医生在处方中开出利尿降压剂。与医药销售代表相似，本研究中研究者与几个小组的医生尤其是与意见领袖见面，他们详细地介绍了治疗高血压的参考准则、递上研究报告、内部通讯录与诊断室海报等等。一项对处方模式的检验发现：该策略（即“学术攻心术”，或“对意见领袖的连续支持”< academic detailing>）对医生所开的处方药具有影响力。

ALLHAT is sponsored by the National Heart, Lung and Blood Institute. "We are continuing to mine data that we collected during the trial," Whelton said.

ALLHAT计划由国家心肺血液研究所发起。Whelton说：“我们正在继续发掘实验期间收集的数据。”

（Docofsoul译于2010-8-17）