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ALLHATAntihypertensive and Lipid-Lowering Treatment To Prevent Heart Attack Trial
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"This paper reviews the initial findings in light of more detailed analyses of the ALLHAT data and data from more recent clinical trials.
ACCOMPLISH did support, as noted in ALLHAT and many other trials, that calcium channel blockers are safe and effective when used in appropriate patients.
For example, ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) investigators reported that patients randomized to diuretics were more likely to develop new-onset diabetes than patients randomized to either a calcium channel blocker or an ACE inhibitor.
ALLHAT failed to discriminate between the etiologies of hypertension.
ALLHAT was funded by the National Heart, Lung, and Blood Institute.
of Case Western Reserve University, Cleveland, and colleagues compared rates of adverse events among the 37,291 male and female ALLHAT participants with metabolic or cardiometabolic syndrome who were at least aged 55 years and who were randomly assigned to take the calcium-channel blocker amlodipine (Norvasc) (7,945 patients), the [alpha]-blocker doxazosin (Cardura) (7,928 patients), the ACE inhibitor lisinopril (Prinivil, Zestril) (7,948 patients), or the thiazide-type diuretic chlorthalidone (13,470 patients).
"ALLHAT shows that diuretics are the best choice to treat hypertension and reduce the risk of its complications -- both medically and economically," emphasizes Claude Lenfant, NHLBI director.
The design of ALLHAT led to worsened control of BP in African Americans relative to white patients who were receiving lisinopril, which may have been an important factor in the subsequent increased rate of stroke in African American patients who were receiving lisinopril rather than chlorthalidone.
Despite trials such as SHEP and ALLHAT, and despite the long record of safety and efficacy in numerous patient populations, thiazide-type diuretics remain significantly underused in clinical practice.
For example, in the 33,257-patient Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the rates of stroke, heart failure, and combined cardiovascular events were significantly lower in patients on diuretics than in those on ACE inhibitors--findings opposite those of the Australian study.
(3,8-10) In the Antihypertensive and Lipid-Lowering to Prevent Heart Attack Trial (ALLHAT), treatment initiated with the thiazide-type diuretic (THZD) chlorthalidone (CHT) reduced systolic BP (SBP) by 4 mm Hg more than treatment based on the angiotensin-converting enzyme inhibitor (ACEI) lisinopril or the alpha-blocker doxazosin in black ALLHAT participants who were receiving similar background antihypertensive drug treatment.
First, the patients enrolled into ASCOT had a much lower baseline risk for cardiovascular events than did those who were enrolled into ALLHAT, said Peter S.