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ALLHAT—All hit or all miss? Key questions still remain

2003; Elsevier BV; Volume: 92; Issue: 3 Linguagem: Inglês

10.1016/s0002-9149(03)00624-6

1879-1913

Franz H. Messerli, Michael A. Weber,

Pharmacogenetics and Drug Metabolism

For years the selection of first-line therapy for hypertension has been debated with zeal and vehemence that seemed more suitable to medieval heretics than to contemporary scientists. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) 1 The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research GroupMajor 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. 2002; 288: 2981-2997 Crossref PubMed Scopus (5232) Google Scholar was designed to shed light on the issue by comparing outcomes of what were then newer antihypertensives (amlodipine, lisinopril, and doxazosin) with chlorthalidone. To this end, 42,448 patients were randomized to 1 of 4 treatment arms, 1 of which (doxazosin) was discontinued in 2000. 2 Messerli F.H. Implications of discontinuation of doxazosin in arm of ALLHAT. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Lancet. 2000; 355: 863-864 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar The results of ALLHAT have been reported, 1 The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research GroupMajor 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. 2002; 288: 2981-2997 Crossref PubMed Scopus (5232) Google Scholar with the extraordinary conclusion that, "Thiazide-type diuretics are superior in preventing one or more major forms of cardiovascular disease and are less expensive. They should be preferred for first-step antihypertensive therapy."