African Americans in ALLHAT
, treated with lisinopril had systolic and diastolic pressures that were an average of about 4 mm Hg higher than those in blacks treated with chlorthalidone.
The jury appears still to be out, as the controversial ALLHAT
results run counter to those of other major trials-including the HOPE and SOLVD trials-which found that ACE inhibitors are superior to diuretics.
This issue was specifically addressed by the recently published interim analysis of the same ALLHAT
trial when the [alpha]-blocker arm was stopped early because of a 25% greater cardiovascular event rate, as well as a twofold greater risk of heart failure when compared with the diuretic chlorthalidone.
Black, chairman of the department of preventive medicine at Rush University Medical Center, Chicago, said that the ALLHAT
findings hold up well to scrutiny: Chlorthalidone was associated with a reduction in certain end points, including heart failure, stroke, and overall cardiovascular events.
An additional 4 years of follow-up for mortality due to cancer was available through national databases after ALLHAT
For those who didn't achieve blood pressure control by 6 months, the ALLHAT
team re-randomized the groups, added a medication, and improved control from 42% to 55%.
In 2002, the results of the ALLHAT
study became clear.
For example, ALLHAT
and SHEP were landmark clinical trials that have shown that long-term use of chlorthalidone at doses of 12.
Thiazide diuretics are often recommended as the first medication to use to control blood pressure, but I've heard that a large study called ALLHAT
found an association between thiazide diuretics and diabetes.
In 2002, ALLHAT
researchers reported that among patients followed for four-to-eight years, the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and overall cardiovascular disease.
Collaborative Research Group, "Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs.
The latest findings from the "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial" or ALLHAT
, sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, are published in the January 28 issue of "Archives of Internal Medicine"