Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
EFFECT OF DIURETIC-BASED ANTIHYPERTENSIVE TREATMENT ON CARDIOVASCULAR-DISEASE RISK IN OLDER DIABETIC-PATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION
Autore:
CURB JD; PRESSEL SL; CUTLER JA; SAVAGE PJ; APPLEGATE WB; BLACK H; CAMEL G; DAVIS BR; FROST PH; GONZALEZ N; GUTHRIE G; OBERMAN A; RUTAN GH; STAMLER J;
Indirizzi:
SYSTOL HYPERTENS ELDERLY PROGRAM COORDINATING CTR,1200 HERMAN PRESSLER,ROOM 801 HOUSTON TX 77030 UNIV HAWAII,JOHN A BURNS SCH MED HONOLULU HI 96822 UNIV TEXAS,SCH PUBL HLTH HOUSTON TX 00000 NHLBI BETHESDA MD 20892 UNIV TENNESSEE MEMPHIS TN 38163 RUSH PRESBYTERIAN ST LUKES MED CTR CHICAGO IL 60612 WASHINGTON UNIV,SCH MED ST LOUIS MO 00000 UNIV CALIF SAN FRANCISCO SAN FRANCISCO CA 94143 UNIV MINNESOTA MINNEAPOLIS MN 55455 UNIV KENTUCKY LEXINGTON KY 00000 UNIV ALABAMA BIRMINGHAM AL 00000 VET AFFAIRS MED CTR MEMPHIS TN 00000 NORTHWESTERN UNIV CHICAGO IL 60611 SYSTOL HYPERTENS ELDERLY PROGRAM COORDINATING CTR HOUSTON TX 77030
Titolo Testata:
JAMA, the journal of the American Medical Association
fascicolo: 23, volume: 276, anno: 1996,
pagine: 1886 - 1892
SICI:
0098-7484(1996)276:23<1886:EODATO>2.0.ZU;2-5
Fonte:
ISI
Lingua:
ENG
Soggetto:
EUROPEAN WORKING PARTY; HIGH BLOOD-PRESSURE; MORTALITY; MORBIDITY; THERAPY; TRIAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
20
Recensione:
Indirizzi per estratti:
Citazione:
J.D. Curb et al., "EFFECT OF DIURETIC-BASED ANTIHYPERTENSIVE TREATMENT ON CARDIOVASCULAR-DISEASE RISK IN OLDER DIABETIC-PATIENTS WITH ISOLATED SYSTOLIC HYPERTENSION", JAMA, the journal of the American Medical Association, 276(23), 1996, pp. 1886-1892

Abstract

Objective.-To assess the effect of low-dose, diuretic-based antihypertensive treatment on major cardiovascular disease (CVD) event rates inolder, non-insulin-treated diabetic patients with isolated systolic hypertension (ISH), compared with nondiabetic patients. Design.-Double-blind, randomized, placebo-controlled trial: the Systolic Hypertensionin the Elderly Program (SHEP). Setting.-Multiple clinical and supportcenters in the United States. Participants.-A total of 4736 men and women aged 60 years and older at baseline with ISH (systolic blood pressure [BP], greater than or equal to 160 mm Hg; diastolic BP, <90 mm Hg) al baseline, 583 non-insulin-dependent diabetic patients and 4149 nondiabetic patients (4 additional patients not so classifiable were randomized but not included in these analyses). Diabetes mellitus definedas physician diagnosis, taking oral hypoglycemic drugs, fasting glucose level of 7.8 mmol/L or more (greater than or equal to 140 mg/dL), or any combination of these characteristics. Intervention.-The active treatment group received a low dose of chlorthalidone (12.5-25.0 mg/d) with a step-up to atenolol (25.0-50.0 mg/d) or reserpine (0.05-0.10 mg/d) if needed. The placebo group received placebo and any active antihypertensive drugs prescribed by patient's private physician for persistently high BP. Main Outcome Measures.-The 5-year rates of major CVD events, nonfatal plus fatal stroke, nonfatal myocardial infarction (MI)and fatal coronary heart disease (CHD), major CHD events, and all-cause mortality. Results.-The SHEP antihypertensive drug regimen lowered BP of both diabetic and nondiabetic patients, with few adverse effects. For both diabetic and nondiabetic patients, all outcome rates were lower for participants randomized to the active treatment group than for those randomized to the placebo group, Thus, 5-year major CVD rate was lower by 34% for active treatment compared with placebo, both for diabetic patients (95% confidence interval [CI], 6%-54%) and nondiabetic patients (95% CI, 21%-45%). Absolute risk reduction with active treatment compared with placebo was twice as great for diabetic vs nondiabetic patients (101/1000 vs 51/1000 randomized participants at the 5-year follow-up), reflecting the higher risk of diabetic patients. Conclusion.-Low-dose diuretic-based (chlorthalidone) treatment is effective in preventing major CVD events, cerebral and cardiac, in both non-insulin-treated diabetic and nondiabetic cider patients with ISH.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/12/20 alle ore 02:38:40