Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER-Prevention Randomized Clinical Trial.

Autor: Fuchs SC; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil sfuchs@hcpa.edu.br., Poli-de-Figueiredo CE; Faculdade de Medicina, Hospital São Lucas, PUCRS, Porto Alegre, Brazil., Figueiredo Neto JA; Hospital Universitário, Universidade Federal do Maranhão, São Luis, Brazil., Scala LC; Hospital Universitário Júlio Müller, Universidade Federal de Mato Grosso, Cuiabá, Brazil., Whelton PK; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA., Mosele F; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., de Mello RB; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Vilela-Martin JF; Faculdade de Medicina de São José do Rio Preto e Hospital de Base, São José do Rio Preto, Brazil., Moreira LB; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Chaves H; Universidade Federal de Pernambuco, Recife, Brazil., Mota Gomes M; Hospital do Coração, Maceio, Brazil., de Sousa MR; Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Silva RP; Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil., Castro I; Instituto de Cardiologia, Porto Alegre, Brazil., Cesarino EJ; Faculdade de Ciências Farmacêuticas, USP Ribeirão Preto, Ribeirão Preto, Brazil., Jardim PC; Hospital das Clínicas da Universidade Federal de Goiás, Goiania, Brazil., Alves JG; Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil., Steffens AA; Universidade Federal de Pelotas, Pelotas, Brazil., Brandão AA; Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil., Consolim-Colombo FM; Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Brazil., de Alencastro PR; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Neto AA; Hospital do Coração Anis Rassi, Goiania, Brazil., Nóbrega AC; Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niteroi, Brazil., Franco RS; Faculdade de Medicina de Botucatu, Botucatu, Brazil., Sobral Filho DC; Hospital Universitário PROCAPE, Recife, Brazil., Bordignon A; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Nobre F; Faculdade de Medicina de Ribeirão Preto, USP Ribeirão Preto, Ribeirão Preto, Brazil., Schlatter R; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Gus M; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Fuchs FC; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil., Berwanger O; Research Institute HCor Hospital do Coração, São Paulo, Brazil., Fuchs FD; Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2016 Dec 13; Vol. 5 (12). Date of Electronic Publication: 2016 Dec 13.
DOI: 10.1161/JAHA.116.004248
Abstrakt: 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 trial was conducted in 21 Brazilian academic medical centers. Participants with prehypertension who were aged 30 to 70 years and who 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 with 358 allocated to placebo (hazard ratio 0.56, 95% CI 0.38-0.82), resulting in a cumulative incidence of 11.7% 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.
Clinical Trial Registration: URL: http://www.ClinicalTrials.gov, www.ensaiosclinicos.gov. Unique identifiers: NCT00970931, RBR-74rr6s.
(© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
Databáze: MEDLINE
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