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ALLHAT: Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial

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ALLHAT: Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial

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    1. ALLHAT: Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial Purpose To determine whether, in hypertensive patients, the calcium channel blocker amlodipine or the angiotensin converting enzyme inhibitor lisinopril reduces coronary heart disease and other cardiovascular disease compared with the thiazide diuretic chlorthalidone Reference The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major 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. JAMA 2002;288:2981–97.

    2. ALLHAT: Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial - TRIAL DESIGN - Design Multicenter, multinational, randomized, double-blind, parallel group Patients 33,357 patients aged >55 years with hypertension and >1 other risk factor for CHD events (including previous MI, stroke and other atherosclerotic cardiovascular events, and LV hypertrophy). Patients with history of heart failure or LVEF <35% were excluded Follow up and primary endpoint Primary combined endpoint: fatal CHD and nonfatal MI. Mean 4.9 years follow up. Treatment Chlorthalidone 12.5–25 mg, amlodipine 2.5–10 mg or lisinopril 10–40 mg daily, each titrated to to achieve target BP 140/90 mmHg. Prior antihypertensive therapy discontinued at randomization. Addition of open-label agents permitted if BP goal not achieved

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    4. ALLHAT: Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial - RESULTS - No significant difference between amlodipine and chlorthalidone or between lisinopril and chlorthalidone in: primary combined endpoint of fatal CHD and nonfatal MI: amlodipine relative risk 0.98 (95% CI 0.90–1.07, P=0.65), lisinopril relative risk 0.99 (95% CI 0.91–1.08, P=0.81) all-cause mortality at 6 years (amlodipine 16.8%, lisinopril 17.2%, chlorthalidone 17.3%; compared with chlorthalidone P=0.2 for amlodipine and P=0.9 for lisinopril) Compared with chlorthalidone, systolic BP significantly higher with amlodipine and lisinopril, but diastolic BP significantly reduced with amlodipine In achieving BP goal of <140/90 mmHg, no significant difference between amlodipine and chlorthalidone; but significantly fewer patients achieved goal with lisinopril than with chlorthalidone

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    6. ALLHAT: Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial - RESULTS continued -

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    8. ALLHAT: Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial - SUMMARY - In patients with hypertension and at least one other risk factor for CHD, when compared with chlorthalidone: Neither amlodipine nor lisinopril conferred benefit on the primary combined endpoint of fatal CHD and nonfatal MI or on endpoint of all-cause mortality Systolic BP was significantly higher with both agents; diastolic BP was reduced with amlodipine Proportion of patients achieving BP goal was the same with amlodipine but was significantly lower with lisinopril

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