ALLHAT (Antihypertensive and LipidLowering Treatment to Prevent HeartAttack Trial)
ALLHAT (Antihypertensive and Lipid LoweringTreatment 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 outcomesAmlodipine vs chlorthalidoneEnd point Amlodipine (%) Chlorthalidone (%) Relative risk (95% CI) p6-y rate of heart failure 10.2 7.7 1.38 (1.25–1.52) <0.001Lisinopril vs chlorthalidoneEnd point Lisinopril (%) Chlorthalidone (%) Relative risk (95% CI) p6-y rate of combined CVD 33.3 30.9 1.10 (1.05–1.16) <0.0016-y rate of stroke 6.3 5.6 1.15 (1.02–1.30) 0.026-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 areactually better are not being used because theres no one out there selling them todoctors, who depend on sales reps for their information?" - Dr Robert M Califf"Here is a huge clinical trial thats 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 asuperficial economic and political conclusion that seems to run counter to thescientific 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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