TY - JOUR
T1 - Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic
T2 - The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)
AU - Furberg, Curt D.
AU - Wright, Jackson T.
AU - Davis, Barry R.
AU - Cutler, Jeffrey A.
AU - Alderman, Michael
AU - Black, Henry
AU - Cushman, William
AU - Grimm, Richard
AU - Haywood, L. Julian
AU - Leenen, Frans
AU - Oparil, Suzanne
AU - Probstfield, Jeffrey
AU - Whelton, Paul
AU - Nwachuku, Chuke
AU - Gordon, David
AU - Proschan, Michael
AU - Einhom, Paula
AU - Ford, Charles E.
AU - Piller, Linda B.
AU - Dunn, I. Kay
AU - Goff, David
AU - Pressel, Sara
AU - Bettencourt, Judy
AU - DeLeon, Barbara
AU - Simpson, Lara M.
AU - Blanton, Joe
AU - Geraci, Therese
AU - Walsh, Sandra M.
AU - Nelson, Christine
AU - Rahman, Mahboob
AU - Juratovac, Anne
AU - Pospisil, Robert
AU - Carroll, Lillian
AU - Sullivan, Sheila
AU - Russo, Jeanne
AU - Barone, Gail
AU - Christian, Rudy
AU - Feldman, Sharon
AU - Lucente, Tracy
AU - Calhoun, David
AU - Jenkins, Kim
AU - McDowell, Peggy
AU - Johnson, Janice
AU - Kingry, Connie
AU - Alzate, Juan
AU - Margolis, Karen L.
AU - Holland-Klemme, Leslie Ann
AU - Jaeger, Brenda
AU - Williamson, Jeffrey
AU - Louis, Gail
AU - Ragusa, Pamela
AU - Williard, Angela
AU - Ferguson, R. L Sue
AU - Tanner, Joanna
AU - Eckfeldt, John
AU - Crow, Richard
AU - Pelosi, John
PY - 2002/12/18
Y1 - 2002/12/18
N2 - Context: Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is unknown. Objective: To determine whether treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. Design: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, active-controlled clinical trial conducted from February 1994 through March 2002. Setting and Participants: A total of 33 357 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from 623 North American centers. Interventions: Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n = 15255); amlodipine, 2.5 to 10 mg/d (n =9048); or lisinopril, 10 to 40 mg/d (n=9054) for planned follow-up of approximately 4 to 8 years. Main Outcome Measures: The primary outcome was combined fatal CHD or nonfatal myocardial infarction, analyzed by intent-to-treat. Secondary outcomes were all-cause mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined 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 2956 participants, with no difference between treatments. Compared with chlorthalidone (6-year rate, 11.5%), the relative risks (RRs) were 0.98 (95% Cl, 0.90-1.07) for amlodipine (6-year rate, 11.3%) and 0.99 (95% Cl, 0.91-1.08) for lisinopril (6-year rate, 11.4%). Likewise, all-cause mortality did not differ between groups. Five-year systolic blood pressures were significantly higher in the amiodipine (0.8 mm Hg, P=.03) and lisinopril (2 mm Hg, P<.001) groups compared with chlorthalidone, and 5-year diastolic blood pressure was significantly lower with amlodipine (0.8 mm Hg, P<.001). For amlodipine vs chiorthalidone, secondary outcomes were similar except for a higher 6-year rate of HF with amlodipine (10.2% vs 7.7%; RR, 1.38; 95% Cl, 1.25-1.52). For lisinopril vs chlorthalidone, lisinopril had higher 6-year rates of combined CVD (33.3% vs 30.9%; RR, 1.10; 95% Cl, 1.05-1.16); stroke (6.3% vs 5.6%; RR, 1.15; 95% Cl, 1.02-1.30); and HF (8.7% vs 7.7%; RR, 1.19; 95% Cl, 1.07-1.31). Conclusion: Thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive. They should be preferred for first-step antihypertensive therapy.
AB - Context: Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is unknown. Objective: To determine whether treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. Design: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, active-controlled clinical trial conducted from February 1994 through March 2002. Setting and Participants: A total of 33 357 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from 623 North American centers. Interventions: Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n = 15255); amlodipine, 2.5 to 10 mg/d (n =9048); or lisinopril, 10 to 40 mg/d (n=9054) for planned follow-up of approximately 4 to 8 years. Main Outcome Measures: The primary outcome was combined fatal CHD or nonfatal myocardial infarction, analyzed by intent-to-treat. Secondary outcomes were all-cause mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined 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 2956 participants, with no difference between treatments. Compared with chlorthalidone (6-year rate, 11.5%), the relative risks (RRs) were 0.98 (95% Cl, 0.90-1.07) for amlodipine (6-year rate, 11.3%) and 0.99 (95% Cl, 0.91-1.08) for lisinopril (6-year rate, 11.4%). Likewise, all-cause mortality did not differ between groups. Five-year systolic blood pressures were significantly higher in the amiodipine (0.8 mm Hg, P=.03) and lisinopril (2 mm Hg, P<.001) groups compared with chlorthalidone, and 5-year diastolic blood pressure was significantly lower with amlodipine (0.8 mm Hg, P<.001). For amlodipine vs chiorthalidone, secondary outcomes were similar except for a higher 6-year rate of HF with amlodipine (10.2% vs 7.7%; RR, 1.38; 95% Cl, 1.25-1.52). For lisinopril vs chlorthalidone, lisinopril had higher 6-year rates of combined CVD (33.3% vs 30.9%; RR, 1.10; 95% Cl, 1.05-1.16); stroke (6.3% vs 5.6%; RR, 1.15; 95% Cl, 1.02-1.30); and HF (8.7% vs 7.7%; RR, 1.19; 95% Cl, 1.07-1.31). Conclusion: Thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive. They should be preferred for first-step antihypertensive therapy.
UR - http://www.scopus.com/inward/record.url?scp=0344373794&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0344373794&partnerID=8YFLogxK
U2 - 10.1001/jama.288.23.2981
DO - 10.1001/jama.288.23.2981
M3 - Article
C2 - 12479763
AN - SCOPUS:0344373794
SN - 0098-7484
VL - 288
SP - 2981
EP - 2997
JO - Journal of the American Medical Association
JF - Journal of the American Medical Association
IS - 23
ER -