Antihypertensive And Lipid-Lowering Treatment To Prevent Heart Attack Trial

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Click here to download slides for ALLHAT trial.

Overview

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial compared major outcomes in high risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. No significant difference was observed on CHD mortality in the group treated with pravastatin 40 mg daily as compared to the usual care group with well controlled hypertension and moderately elevated LDL. Possible explanations for failure to observe a significant reduction included a modest reduction in total cholesterol, unblinded study with no placebo group and a large crossover of high risk subjects[1]

Design

Randomized, double-blind, multi-center clinical trial

Interventions

Control arm:

Comparators:

Endpoint

Determine whether occurrence of fatal CHD or nonfatal MI is lower for high-risk hypertensive patients treated with newer agents (CCB, ACEI, alpha-blocker) compared with a diuretic

Population

42,418 high-risk hypertensive patients ≥ 55 years

Results

The alpha blocker arm (doxazosin) was dropped early due to futility.

  • There were no significant differences among the comparator arms in the primary outcome.
  • With respect to stroke ACEi was better than the diuretic or CCB
  • With respect to heart Failure ACEi/CCB was better than the diuretic

References

  1. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (2002). "Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT).". JAMA. 288 (23): 2998–3007. PMID 12479764.  Review in: ACP J Club. 2003 Jul-Aug;139(1):10

Cardiology


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