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The ALLHAT Study

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	STUDY

 
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 288:2981–2997, 2002[Abstract/Free Full Text]

	SUMMARY

 
Design. A randomized, double-blind, active-controlled clinical trial conducted from February 1994 through March 2002. Participants with hypertension were randomly assigned to receive chlorthalidone, 12.5–25 mg/day (n = 15,255); amlodipine, 2.5–10 mg/day (n = 9,048); or lisinopril, 10–40 mg/day (n = 9,054) for planned follow-up of 4–8 years.

Participants. A total of 33,357 participants aged 55 years with hypertension and at least one other coronary heart disease (CHD) risk factor from 623 North American centers; 12,063 participants had diabetes.

Primary hypothesis. The primary outcome was combined fatal CHD or nonfatal myocardial infarction (MI), analyzed by intent-to-treat.

Secondary hypotheses. Secondary outcomes were total mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined cardiovascular disease (CVD) (combined CHD, stroke, treated angina without hospitalization, heart failure [HF], and peripheral arterial disease).

Results. Mean follow-up was 4.9 years. The primary outcome occurred in 2,956 participants, with no difference between treatments. Compared with chlorthalidone, the relative risks (RRs) were 0.98 (95% CI, 0.90–1.07) for amlodipine and 0.99 (95% CI, 0.91–1.08) for lisinopril. Likewise, all-cause mortality did not differ between groups. For amlodipine versus chlorthalidone, secondary outcomes were similar except for a higher 6-year rate of HF with amlodipine (10.2 vs. 7.7%; RR, 1.38; 95% CI, 1.25–1.52). For lisinopril . . . [Full Text of this Article]

	COMMENTARY

 

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