In a consensus statement developed before the findings from the ALLHAT
subgroup analysis were available, it was noted that racial differences in metabolic syndrome may make the selection of antihypertensive agents particularly important in African American patients.
Michael Weber, professor of medicine at the State University of New York, Downstate, is a long time critic of ALLHAT
, although diabetes occurred more frequently and fasting glucose rose in patients on diuretics, these metabolic abnormalities did not result in more cardiovascular events.
Among African Americans in ALLHAT
, those treated with lisinopril had systolic and diastolic pressures that were an average of about 4 mm Hg higher than the blood pressures of blacks treated with chlorthalidone.
To clarify the issue, they performed a secondary analysis of data from the randomized, open-label ALLHAT
(Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack) trial.
To ensure that facilities of the same type would not be concentrated in one arm, randomization was constrained on hospital teaching status, geographic location, participation in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT
Officers and Coordinators for the ALLHAT
Collaborative Research Group 2002; Cushman et al.
study showed that in hypertensive patients with one or more risk factors for CVD, optimal GFR is determined only in 15% of patients, while 73.
The verdict from ALLHAT
-- thiazide diuretics are the preferred initial therapy for hypertension.
In the JAMA Internal Medicine study, Marcus and his colleagues utilized electrocardiograms at enrollment and every two years of follow up for eight years from the National Institutes of Health-funded ALLHAT
(Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial).
Blood pressure control and cardiovascular outcomes in normal-weight, overweight, and obese hypertensive patients treated with three different antihypertensivesin ALLHAT
If we were to compile all of the well-known studies, including JUPITER, CORONA, LIPID, WOSCOPS, PROSPER, MEGA, GISSI-HF, GISSI PREV, ALLHAT
, 45, ASCOTLLA, HPS, and AFCAPS/TEXCAPS, we would have a total of 90,056 patients.
Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH, Black HR, Hamilton BP, Holland J, Nwachuku C, Papademetriou V, Probstfield J, Wright JT, Alderman MH, Weiss RJ, Piller L, Bettencourt J, Walsh SM, for the ALLHAT
Collaborative Research Group.