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The ALLHAT trial

2003; Lippincott Williams & Wilkins; Volume: 21; Issue: 2 Linguagem: Inglês

10.1097/00004872-200302000-00001

1473-5598

Alberto Zanchetti, Giuseppe Mancia,

Blood Pressure and Hypertension Studies

The recent publication of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial results has prompted the Editors of the Journal of Hypertension to invite commentaries from respected experts from various parts of the world. We believe that this is the best recognition that a scientific journal can give to the relevance of a study; a relevance that all the commentaries explicitly underline. The Editors have also asked the four experts to express their criticisms and what they think are the limitations of the trial. Indeed, we feel that too often the results of a trial, even of an excellent trial such as ALLHAT, are taken as a verdict, rather than a challenge, as the results of any investigation should be. There have been too many 'verdicts' in the past history of hypertension research, some of which disproved by the ALLHAT results themselves. The readers of the Journal of Hypertension will be interested in learning how much all the invited commentators have appreciated the conduct and the outcome of the study, but they will certainly be equally interested in knowing which questions the ALLHAT trial has not answered and are still left open. These are mostly those inherent in the nature of large event-based trials. Can the results of 4–5 years of treatment be extrapolated to the much longer life expectation of middle-aged hypertensive patients? Can some of the metabolic changes differently occurring with different drug regimens have some impact on a longer time course than the 5-year duration of a trial? Did the peculiar and unusual combination therapy required by the ALLHAT design have some influence on the results, and did it cause some disadvantage, in particular to ACE inhibitors? How can the ALLHAT trial results on renal outcomes be reconciled with the quite different results of several other studies? Will a meta-analysis of all these renal studies clarify the matter, or rather confound cows of different colours in the obscurity of the night? We must be grateful to the authors of ALLHAT for contributing an imposing mass of clinically relevant data, which all those working in the area of hypertension cannot obviously ignore, but should use with a critical mind as a challenge to learn more and do better in the management of the individual hypertensive patient.