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1、VALUEandMATCH:AneraofcomparativeclinicaltrialsEricJTopolMDProvostandChiefAcademicOfficer Chairman,DepartmentofCardiovascularMedicine ClevelandClinicFoundation Cleveland,OHRobertMCaliffMDProfessorofMedicine AssociateViceChancellorforClinicalResearch Director,DukeClinicalResearchInsti
2、tute DukeUniversityMedicalCenter Durham,NCVALUEValsartanAntihypertensiveLong-TermUseEvaluationMATCHManagementofAtherothrombosiswithClopidogrelinHigh-RiskPatientswithRecentTransientIschemicAttacksorIschemicStrokeTopicsValsartanAntihypertensiveLong-TermUseEvaluationVALUEVALUE:GoalTria
3、ldesignedtocomparetwotreatmentstrategies:amlodipine(Norvasc®,Pfizer)andvalsartan(Diovan®,Novartis).(Lancet2004Jun19;363:2022-31.)STUDYAIMIfsimilarblood-pressurecontrolcouldbeachievedwithbothdrugs,wouldtherebeanybeneficialeffectoncardiacendpointswithvalsartanbeyondblood-pressurelower
4、ingalone?PrimaryendpointacompositeofcardiacmorbidityormortalityVALUE:DesignTrialinvolved15245hypertensivepatientswithatleastonehigh-riskfeature,includingCAD,previousstrokeorTIA,peripheralvasculardisease,ordiabetesPatientsrandomizedtovalsartan80mgoramlodipine5mgPatientsalreadyonBP-lo
5、weringmedications"rolledover"toeitheramlodipineorvalsartanAtonemonth,iftargetBPnot<140/90mmHg,patientsup-titratedtovalsartan160mgandamlodipine10mg;hydrochlorothiazideaddedinincreasingdosesifcontrolnotachievedVALUE:PrimarycompositeendpointEndpointValsartanAmlodipineHazardratio(95%CI)
6、pPrimarycomposite,n(%)810(10.6)789(10.4)1.04(0.94-1.15)0.49Cardiacmortality,n(%)304(4.0)304(4.0)1.01(0.86-1.18)0.90Cardiacmorbidity,n(%)586(7.7)578(7.6)1.02(0.91-1.15)0.71Lancet2004;363VALUE:SystolicBPovertimebytreatmentgroupTimepointValsartanAmlodipinepBaseline154.5+19.0154.8+19.0<
7、0.0001Onemonth152.7+17.5148.7+17.4<0.0001Threemonths149.2+19.5145.4+16.1<0.0001Final139.3+17.6137.5+15.0<0.0001Lancet2004;363VALUE:Secondaryandprespecified endpointsEndpointValsartanAmlodipineHR(95%CI)pFatalandnonfatalMI,n(%)369(4.8)313(4.1)1.19(1.02-1.38)0.02FatalMI,n(%)66(0.86)64(
8、0.84)1.04(0.74-1.47
