http://www.theheart.org/web_slides/1135409.do
A study on antihypertensive and lipid lowering treatment to prevent heart attack (ALLHAT) using patients with hypertension and at least one other risk factor were randomized to chlothalidone.
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)
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