ALLHAT
Antihypertensive and Lipid-Lowering Treament to Prevent Heart Attack Trial
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Status:
Trial complete. Results published December 2002.
Purpose:
To determine if a treatment regime based on calcium channel blocker or angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease or other cardiovascular disease events vs diuretic treatments.
Interventions:
Antihypertensives
This category includes all BP lowering drugs in stroke prevention trials
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Location(s):
United States & Canada
Year Started:
1994
Year Finished:
2002
Design:
Randomized, double-blind, active-controlled clinical trial.
Inclusion Criteria
Patients 55 years and older with hypertension and at least one other coronary heart disease risk factor.
Exclusion Criteria
Patients with symptomatic heart failure and/or left ventricular ejection fraction of less than 35%.
Patient Involvement:
Patients were randomly assigned to receive either chlorthalidone (12.-25 mg/day, n=15255), amlodipine (2.5-10 mg/day, n=9048) or lisinopril (10-40 mg/day, n=9054). Follow-up visits were at 1 month, 3, 6, 9, 12 months, and every 4 months until the end of the trial.
Primary Outcome:
Combined fatal coronary heart disease or non-fatal myocardial infarction.
Secondary Outcome:
All causes of mortality, stroke, combined coronary heart disease, combined cardiovascular disease.
Results:
Mean follow-up was 4.9 years. The primary outcome occurred in 2956 participants, with no difference between treatments. Compared with chlorthalidone (6-year rate, 11.5%), the relative risks (RRs) were 0.98 (95% CI, 0.90-1.07) for amlodipine (6-year rate, 11.3%) and 0.99 (95% CI, 0.91-1.08) for lisinopril (6-year rate, 11.4%). Likewise, all-cause mortality did not differ between groups. Five-year systolic blood pressures were significantly higher in the amlodipine (0.8 mm Hg, P = .03) and lisinopril (2 mm Hg, P<.001) groups compared with chlorthalidone, and 5-year diastolic blood pressure was significantly lower with amlodipine (0.8 mm Hg, P<.001). For amlodipine vs chlorthalidone, secondary outcomes were similar except for a higher 6-year rate of HF with amlodipine (10.2% vs 7.7%; RR, 1.38; 95% CI, 1.25-1.52). For lisinopril vs chlorthalidone, lisinopril had higher 6-year rates of combined CVD (33.3% vs 30.9%; RR, 1.10; 95% CI, 1.05-1.16); stroke (6.3% vs 5.6%; RR, 1.15; 95% CI, 1.02-1.30); and HF (8.7% vs 7.7%; RR, 1.19; 95% CI, 1.07-1.31).
Source of Information:
JAMA 2002;288:2981-1997.
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Web Links and Publications:
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This information last updated on: 10/19/2009
Reviewed on: 10/19/2009.
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