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ALLHAT (Antihypertensive and Lipid
Lowering Treatment to Prevent Heart
Attack Trial)
ALLHAT (Antihypertensive and Lipid Lowering
Treatment to Prevent Heart Attack Trial)

• Background:
   While there may be theoretical advantages of newer antihypertensives over
   diuretics, this has never been shown.
• Population and treatment:
   33 357 patients ≥ 55 years of age with hypertension and at least one other
   risk factor were randomized to chlorthalidone (12.5–25 mg/day, n=15 255),
   amlodipine (2.5–10 mg/day, n=9048), or lisinopril (10–40 mg/day, n=9054).
• Outcomes:
   Primary end point: combined incidence of fatal CHD or nonfatal MI.
   Secondary end points: all-cause mortality, stroke, combined CHD (fatal CHD,
   nonfatal MI, coronary revascularization, or angina with hospitalization), or
   combined CV disease (combined CHD plus stroke, treated angina without
   hospitalization, HF, and PAD).
ALLHAT: Results
• The incidence of the primary outcome was identical in the three treatment groups
  (p=0.81 and p=0.65 vs chlorthalidone for lisinopril and amlodipine, respectively)

Secondary outcomes
Amlodipine vs chlorthalidone

End point                      Amlodipine (%)   Chlorthalidone (%)   Relative risk (95% CI)   p

6-y rate of heart failure      10.2             7.7                  1.38 (1.25–1.52)         <0.001

Lisinopril vs chlorthalidone

End point                      Lisinopril (%)   Chlorthalidone (%)   Relative risk (95% CI)   p

6-y rate of combined CVD       33.3             30.9                 1.10 (1.05–1.16)         <0.001

6-y rate of stroke             6.3              5.6                  1.15 (1.02–1.30)         0.02

6-y rate of HF                 8.7              7.7                  1.19 (1.07–1.31)         <0.001
ALLHAT: Commentary*

"The real news here is, who knows what other inexpensive generic drugs that are
actually better are not being used because there's no one out there selling them to
doctors, who depend on sales reps for their information?"
                                                                - Dr Robert M Califf


"Here is a huge clinical trial that's taken a lot of time, a lot of money, a lot of energy,
and the participation of a lot of investigators, and in the end, it comes out with a
superficial economic and political conclusion that seems to run counter to the
scientific findings."

                                                                                   - Dr Michael Weber




*All comments from ALLHAT: Diuretic the best bet as a first step in hypertension
(http://www.theheart.org/article/263451.do)
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We are the top provider of news and opinions for over 100 000 physicians.

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ALLHAT trial - Summary & Results

  • 1. ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial)
  • 2. ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) • Background: While there may be theoretical advantages of newer antihypertensives over diuretics, this has never been shown. • Population and treatment: 33 357 patients ≥ 55 years of age with hypertension and at least one other risk factor were randomized to chlorthalidone (12.5–25 mg/day, n=15 255), amlodipine (2.5–10 mg/day, n=9048), or lisinopril (10–40 mg/day, n=9054). • Outcomes: Primary end point: combined incidence of fatal CHD or nonfatal MI. Secondary end points: all-cause mortality, stroke, combined CHD (fatal CHD, nonfatal MI, coronary revascularization, or angina with hospitalization), or combined CV disease (combined CHD plus stroke, treated angina without hospitalization, HF, and PAD).
  • 3. ALLHAT: Results • The incidence of the primary outcome was identical in the three treatment groups (p=0.81 and p=0.65 vs chlorthalidone for lisinopril and amlodipine, respectively) Secondary outcomes Amlodipine vs chlorthalidone End point Amlodipine (%) Chlorthalidone (%) Relative risk (95% CI) p 6-y rate of heart failure 10.2 7.7 1.38 (1.25–1.52) <0.001 Lisinopril vs chlorthalidone End point Lisinopril (%) Chlorthalidone (%) Relative risk (95% CI) p 6-y rate of combined CVD 33.3 30.9 1.10 (1.05–1.16) <0.001 6-y rate of stroke 6.3 5.6 1.15 (1.02–1.30) 0.02 6-y rate of HF 8.7 7.7 1.19 (1.07–1.31) <0.001
  • 4. ALLHAT: Commentary* "The real news here is, who knows what other inexpensive generic drugs that are actually better are not being used because there's no one out there selling them to doctors, who depend on sales reps for their information?" - Dr Robert M Califf "Here is a huge clinical trial that's taken a lot of time, a lot of money, a lot of energy, and the participation of a lot of investigators, and in the end, it comes out with a superficial economic and political conclusion that seems to run counter to the scientific findings." - Dr Michael Weber *All comments from ALLHAT: Diuretic the best bet as a first step in hypertension (http://www.theheart.org/article/263451.do)
  • 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorg theheart.org is the leading online source of independent cardiology news. We are the top provider of news and opinions for over 100 000 physicians.