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Huyết áp và xơ vữa động mạch: Những hệ quả lâm sàng từ thử nghiệm ALLHAT
Tóm tắt
Bằng cách không nhận ra sự không đồng nhất của huyết áp cao, các tác giả của nghiên cứu Thử nghiệm Điều trị Chống Tăng Huyết Áp và Giảm Lipid để Ngăn Ngừa Cơn Đau Tim (ALLHAT) đã sử dụng một tiền đề sai lầm để thực hiện một thử nghiệm lâm sàng được thiết kế kém. Bằng cách không kiểm soát huyết áp đồng đều giữa các nhóm thuốc trong nghiên cứu, ALLHAT không thể được xem là một thử nghiệm so sánh xác định. Không phải là một thử nghiệm monotherapy cũng như một thử nghiệm khởi xướng liệu pháp kiểm soát huyết áp, ALLHAT không cung cấp dữ liệu nào để khuyến nghị liệu pháp tuyến đầu cho huyết áp cao, khiến các kết luận trở nên không hợp lệ. Thuốc lợi tiểu loại thiazide làm tăng angiotensin II và do đó thúc đẩy xơ vữa động mạch và xơ cứng tiểu động mạch. Các chất ức chế men chuyển angiotensin và các chất chẹn thụ thể angiotensin làm chậm lại quá trình xơ vữa động mạch và có tác dụng bảo vệ thận. Nhiều thử nghiệm ngẫu nhiên có kiểm soát cho thấy các kết quả lâm sàng có lợi, bao gồm bảo vệ tim mạch và bảo vệ thận, với sự sử dụng các chất ức chế men chuyển angiotensin và các chất chẹn thụ thể angiotensin. Những tác nhân này, chứ không phải thuốc lợi tiểu loại thiazide, nên được sử dụng như là những tác nhân tuyến đầu để làm chậm quá trình xơ vữa động mạch và các kết quả lâm sàng của nó trong bối cảnh huyết áp động mạch cao.
Từ khóa
#Huyết áp #xơ vữa động mạch #thử nghiệm ALLHAT #thuốc lợi tiểu #thuốc ức chế men chuyển angiotensin #thuốc chẹn thụ thể angiotensin.Tài liệu tham khảo
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