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Effectiveness of chlorthalidone plus amiloride for the prevention of hypertension: the PREVER-prevention randomized clinical trial
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نویسنده
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fuchs s.c. ,poli-de-figueiredo c.e. ,figueiredo neto j.a. ,scala l.c.n. ,whelton p.k. ,mosele f. ,de mello r.b. ,vilela-martin j.f. ,moreira l.b. ,chaves h. ,gomes m.m. ,de sousa m.r. ,pereira e silva r. ,castro i. ,cesarino e.j. ,jardim p.c. ,alves j.g. ,steffens a.a. ,brandão a.a. ,consolim-colombo f.m. ,de alencastro p.r. ,neto a.a. ,nóbrega a.c. ,franco r.s. ,filho d.c.s. ,bordignon a. ,nobre f. ,schlatter r. ,gus m. ,fuchs f.c. ,berwanger o. ,fuchs f.d.
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منبع
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journal of the american heart association - 2016 - دوره : 5 - شماره : 12
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چکیده
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Background-prehypertension is associated with higher cardiovascular risk,target organ damage,and incidence of hypertension. the prevention of hypertension in patients with prehypertension (prever-prevention) trial aimed to evaluate the efficacy and safety of a low-dose diuretic for the prevention of hypertension and end-organ damage. methods and results-this randomized,parallel,double-blind,placebo-controlled trialwas conducted in 21 brazilian academicmedical centers. participants with prehypertensionwho were aged 30 to70 years andwho did not reach optimal blood pressure after 3 months of lifestyle intervention were randomized to a chlorthalidone/amiloride combination pill or placebo and were evaluated every 3 months during 18 months of treatment. the primary outcome was incidence of hypertension. development or worsening of microalbuminuria,new-onset diabetes mellitus,and reduction of left ventricular mass were secondary outcomes. participant characteristics were evenly distributed by trial arms. the incidence of hypertension was significantly lower in 372 study participants allocated to diuretics compared with358 allocated to placebo (hazard ratio 0.56,95%ci 0.38-0.82),resulting in a cumulative incidence of11.7% in the diuretic arm versus 19.5% in the placebo arm(p=0.004). adverse events; levels of blood glucose,glycosylated hemoglobin,creatinine,and microalbuminuria; and incidence of diabetes mellitus were no different between the 2 arms. left ventricular mass assessed through sokolow-lyon voltage and voltage-duration product decreased to a greater extent in participants allocated to diuretic therapy compared with placebo (p=0.02). conclusions-a combination of low-dose chlorthalidone and amiloride effectively reduces the risk of incident hypertension and beneficially affects left ventricular mass in patients with prehypertension. © 2016 the authors.
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کلیدواژه
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Amiloride; Blood pressure; Cardiovascular diseases; Chlorthalidone; Clinical trials; Diuretics; Hypertension; Left ventricular mass; Microalbuminuria; Potassium-sparing antihypertensive agents; Prehypertension; Prevention
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آدرس
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division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, faculdade de medicina,hospital são lucas,pucrs,porto alegre, Brazil, hospital universitário,universidade federal do maranhão,são luis, Brazil, hospital universitário júlio müller,universidade federal dematogrosso,cuiabá, Brazil, department of epidemiology,tulane university school of public health and tropical medicine,new orleans,la, United States, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, faculdade de medicina de são josé do rio preto e hospital de base,são josé do rio preto, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, universidade federal de pernambuco,recife, Brazil, hospital do coração,maceio, Brazil, hospital das clínicas da universidade federal de minas gerais,belo horizonte, Brazil, hospital universitário walter cantídio,universidade federal do ceará,fortaleza, Brazil, instituto de cardiologia,porto alegre, Brazil, faculdade de ciências farmacêuticas,usp ribeirão preto,ribeirão preto, Brazil, hospital das clínicas da universidade federal de goiás,goiania, Brazil, instituto de medicina integral prof. fernando figueira,recife, Brazil, universidade federal de pelotas,pelotas, Brazil, universidade do estado do rio de janeiro,rio de janeiro, Brazil, instituto do coração,faculdade demedicina,universidade de são paulo, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, hospital do coração anis rassi,goiania, Brazil, hospital universitário antônio pedro,universidade federal fluminense,niteroi, Brazil, faculdade demedicina de botucatu,botucatu, Brazil, hospital universitário procape,recife, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, faculdade de medicina de ribeirão preto,usp ribeirão preto,ribeirão preto, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil, research institute hcor hospital do coração,são paulo, Brazil, division of cardiology,hospital de clinicas de porto alegre,universidade federal do rio grande do sul,porto alegre, Brazil
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Authors
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