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1.
Arch Intern Med ; 168(2): 207-17, 2008 Jan 28.
Article in English | MEDLINE | ID: mdl-18227370

ABSTRACT

BACKGROUND: Antihypertensive drugs with favorable metabolic effects are advocated for first-line therapy in hypertensive patients with metabolic/cardiometabolic syndrome (MetS). We compared outcomes by race in hypertensive individuals with and without MetS treated with a thiazide-type diuretic (chlorthalidone), a calcium channel blocker (amlodipine besylate), an alpha-blocker (doxazosin mesylate), or an angiotensin-converting enzyme inhibitor (lisinopril). METHODS: A subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind hypertension treatment trial of 42 418 participants. We defined MetS as hypertension plus at least 2 of the following: fasting serum glucose level of at least 100 mg/dL, body mass index (calculated as weight in kilograms divided by height in meters squared) of at least 30, fasting triglyceride levels of at least 150 mg/dL, and high-density lipoprotein cholesterol levels of less than 40 mg/dL in men or less than 50 mg/dL in women. RESULTS: Significantly higher rates of heart failure were consistent across all treatment comparisons in those with MetS. Relative risks (RRs) were 1.50 (95% confidence interval, 1.18-1.90), 1.49 (1.17-1.90), and 1.88 (1.42-2.47) in black participants and 1.25 (1.06-1.47), 1.20 (1.01-1.41), and 1.82 (1.51-2.19) in nonblack participants for amlodipine, lisinopril, and doxazosin comparisons with chlorthalidone, respectively. Higher rates for combined cardiovascular disease were observed with lisinopril-chlorthalidone (RRs, 1.24 [1.09-1.40] and 1.10 [1.02-1.19], respectively) and doxazosin-chlorthalidone comparisons (RRs, 1.37 [1.19-1.58] and 1.18 [1.08-1.30], respectively) in black and nonblack participants with MetS. Higher rates of stroke were seen in black participants only (RR, 1.37 [1.07-1.76] for the lisinopril-chlorthalidone comparison, and RR, 1.49 [1.09-2.03] for the doxazosin-chlorthalidone comparison). Black patients with MetS also had higher rates of end-stage renal disease (RR, 1.70 [1.13-2.55]) with lisinopril compared with chlorthalidone. CONCLUSIONS: The ALLHAT findings fail to support the preference for calcium channel blockers, alpha-blockers, or angiotensin-converting enzyme inhibitors compared with thiazide-type diuretics in patients with the MetS, despite their more favorable metabolic profiles. This was particularly true for black participants.


Subject(s)
Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Hypertension/ethnology , Metabolic Syndrome/drug therapy , Metabolic Syndrome/ethnology , Aged , Aged, 80 and over , Amlodipine/therapeutic use , Black People , Chlorthalidone/therapeutic use , Double-Blind Method , Doxazosin/therapeutic use , Female , Humans , Lisinopril/therapeutic use , Male , Middle Aged , Treatment Outcome , White People
2.
Am J Cardiol ; 92(1A): 35i-42i, 2003 Jul 03.
Article in English | MEDLINE | ID: mdl-12867253

ABSTRACT

The term metabolic syndrome refers to a virulent and lethal group of atherosclerotic risk factors, including dyslipidemia, insulin resistance, obesity, and hypertension. This syndrome affects some 47 million people in the United States, placing them at increased risk for coronary artery disease (CAD). Particularly prominent as a risk factor for development of heart disease is central obesity. Immediate treatment of the metabolic syndrome is essential because these patients quickly develop diabetes, CAD, and stroke. Treatment is a multifactorial process and includes diet, exercise, and pharmacologic therapy. The latter consists of statins, fibrates, angiotensin-converting enzyme inhibitors, and thiazolidinediones, all of which can decrease the risk and incidence of CAD.


Subject(s)
Metabolic Syndrome/diagnosis , Metabolic Syndrome/prevention & control , Coronary Artery Disease/epidemiology , Coronary Artery Disease/etiology , Coronary Artery Disease/physiopathology , Humans , Metabolic Syndrome/therapy , Risk Factors , Risk Reduction Behavior , United States
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