RESUMO
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in 33,357 high-risk hypertensive participants. ALLHAT compared cardiovascular disease outcomes in participants initially treated with an angiotensin-converting enzyme inhibitor (lisinopril), a calcium channel blocker (amlodipine), or a thiazide-type diuretic (chlorthalidone). We report stroke outcomes in 1517 participants in-trial and 1596 additional participants during post-trial passive surveillance, for a total follow-up of 8-13 years. Stroke rates were higher with lisinopril (6-year rate/100 = 6.4) than with chlorthalidone (5.8) or amlodipine (5.5) in-trial but not including post-trial (10-year rates/100 = 13.2 [chlorthalidone], 13.1[amlodipine], and 13.7 [lisinopril]). In-trial differences were driven by race (race-by-lisinopril/chlorthalidone interaction P = .005, race-by-amlodipine/lisinopril interaction P = .012) and gender (gender-by-lisinopril/amlodipine interaction P = .041), separately. No treatment differences overall, or by race or gender, were detected over the 10-year period. No differences appeared among treatment groups in adjusted risk of all-cause mortality including post-trial for participants with nonfatal in-trial strokes. Among Blacks and women, lisinopril was less effective in preventing stroke in-trial than either chlorthalidone or amlodipine, even after adjusting for differences in systolic blood pressure. These differences abated by the end of the post-trial period.
Assuntos
Anlodipino/administração & dosagem , Clortalidona/administração & dosagem , Hipertensão/tratamento farmacológico , Lisinopril/administração & dosagem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Fatores Etários , Idoso , Anlodipino/efeitos adversos , Causas de Morte , Clortalidona/efeitos adversos , Intervalos de Confiança , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Estimativa de Kaplan-Meier , Lisinopril/efeitos adversos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVES: Southeast Arkansas is a primarily rural, low-income area with low breastfeeding rates. Given the demonstrated positive impacts of breastfeeding on a variety of health indicators, it is important to understand and counteract this situation. METHODS: We reviewed the medical records of 1,260 women who delivered infants at the only major hospital in southeastern Arkansas between February 1997 and January 1998 to determine the rate of breastfeeding initiation and to assess associated factors. RESULTS: Only 18% of mothers initiated breastfeeding. Black mothers, unmarried mothers, and those with less than high school education were least likely to breastfeed. Participation in childbirth education classes was positively associated with breastfeeding, but participation in the Supplemental Food Program for Women, Infants, and Children, health care provider, and hospital variables were not predictive in multivariate models. CONCLUSIONS: Breastfeeding promotion programs are clearly needed in this region, and health care providers and the Supplemental Food Program for Women, Infants, and Children can play significant roles.