Amlodipine or lisinopril was not better than chlorthalidone in lowering CHD risk in hypertension

November 2003
ACP Journal Club;Nov/Dec2003, Vol. 139 Issue 3, pA-15
Academic Journal
Although not mentioned by Dr. B.M. Psaty in his commentary where concerns have been raised over the heart failure results in anti-hypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Asymptomatic left ventricular (LV) systolic dysfunction is common in older patients, particularly men and patients with cardiovascular risk factors. ALLHAT participants were high-risk patients, and many may have had asymptomatic LV dysfunction that could have been unmasked at the start of the study by withdrawal of diuretic therapy. The early difference in heart failure (HF) incidence observed between the lisinopril and chlorthalidone groups, as well as the merging of the HF curves toward the end of the trial, is consistent with this possibility. Furthermore, a true difference in HF incidence over 5 years should have resulted in greater mortality in the lisinopril group, this did not occur. A second concern is the validation of the HF endpoint, the diagnosis of which was up to the local ALLHAT investigator. An ALLHAT subcommittee, which reviewed a small fraction of HF hospitalizations, only agreed with 85% of diagnoses. In contrast, blinded endpoint committees in STOP-Hypertension and in ANBP2, both of which included an angiotensin-converting enzyme inhibitor group, found no difference in HF incidence. In the latter study, men appeared to benefit more from ACE inhibitors than diuretics, consistent with the epidemiology of asymptomatic LV dysfunction. Third, there seem to be race-based differences between the lisinopril and chlorthalidone groups with respect to the risks for stroke, and possibly combined coronary heart disease, combined cardiovascular disease, as well as HF. By ignoring the arguments for and against the ALLHAT results, we may neglect to pursue potentially important racial and gender differences in hypertension treatment.


Related Articles

  • The influence of depression on risk development of acute cardiovascular diseases in the female population aged 25-64 in Russia. Gafarov, Valery V.; Panov, Dmitry O.; Gromova, Elena A.; Gagulin, Igor V.; Gafarova, Almira V. // International Journal of Circumpolar Health;2013, Vol. 72, p1 

    Background. Recent studies showed that depression was an independent predictor of mortality from cardiovascular disease in healthy women. Objective. To explore the effect of depression (D) on relative risk (RR) of myocardial infarction (MI) and stroke for 16 years (1995-010) in the female...

  • The Efficacy Of Thrombolytic Treatment On Patients Who Are Above 75 Years Of Age. Keles, Telat; Akar, Nihal; Gürsel, Koray; Canbay, Alper; Sahin, Deniz; Durmaz, Tahir; Diker, Erdem; Aydogdu, Sinan // Internet Journal of Cardiology;2006, Vol. 3 Issue 1, p2 

    Background: For acute myocardial infarction (AMI) patients above the age of 75, the efficacy of thrombolytic treatment could not be demonstrated clearly. Recently, depending on the data obtained from observational studies, it has been advocated that thrombolytic treatment might not be showing...

  • Beta-blockers: recognising the assets in relation to coronary artery disease. Kendall, M. J. // Basic Research in Cardiology;Nov2000 Supplement 1, Vol. 95, pI31 

    Beta-blockers have been shown to reduce the risk of coronary events and reduce the mortality of patients with hypertension and in those who have had a myocardial infarction. Furthermore, the evidence for long-term benefits in these two patient groups are much more convincing for beta-blockers...

  • Which Antihypertensive Agents in Chronic Kidney Disease? Levey, Andrew S.; Uhlig, Katrin // Annals of Internal Medicine;2/7/2006, Vol. 144 Issue 3, p213 

    The article focuses on the outcomes of cardiovascular disease in a subgroup of patients with chronic kidney disease from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). In the study, 33,357 patients were primarily recruited from the offices of family...

  • Endothelial Dysfunction and Cardiovascular Disease: Critical Target for Cell-Based Therapies. Varudkar, Namita M.; Emrani, Heidi; Ebert, Steven N.; Madan, Atul // British Journal of Medicine & Medical Research;6/1/2014, Vol. 4 Issue 16, p3042 

    This review briefly summarizes how cell-based therapeutic interventions are being developed and applied to treat endothelial dysfunction (ED) as a critical clinical target. ED directly contributes to the onset and prognosis for all of the major forms of cardiovascular diseases, including...

  • PSORIASIS UPDATE.  // Dermatology Nursing;Jan/Feb2010, Vol. 22 Issue 1, p5 

    The article reports on the studies on the link of psoriases to other medical conditions in the U.S. A prospective study conducted to female nurses which examines that relationship between psoriasis, diabetes, and hypertension shows that the association of psoriasis with the risk of hypertension...

  • Population Assessment of Future Trajectories in Coronary Heart Disease Mortality. Thorolfsdottir, Rosa Björk; Aspelund, Thor; Capewell, Simon; Critchley, Julia; Gudnason, Vilmundur; Andersen, Karl // PLoS ONE;Jan2014, Vol. 9 Issue 1, p1 

    Background: Coronary heart disease (CHD) mortality rates have been decreasing in Iceland since the 1980s, largely reflecting improvements in cardiovascular risk factors. The purpose of this study was to predict future CHD mortality in Iceland based on potential risk factor trends. Methods and...

  • Diabetes not ethnicity increases risk of MI in Asian people. Patel, J. V. // Nursing Standard;5/21/2008, Vol. 22 Issue 37, p17 

    The article reports on the findings from Midlands and Manchester researchers regarding the relationship between coronary heart disease risk factors among hypertensive patients and the onset of cardiovascular events in Great Britain. Research shows that increased risk of myocardial infarction...

  • Secondary Prevention of Coronary Heart Disease in Elderly Patients. Hanna, Ibrahim R.; Wenger, Nanette K. // American Family Physician;6/15/2005, Vol. 71 Issue 12, p2289 

    Coronary heart disease remains a leading cause of mortality in the United States, with 84 percent of persons 65 years or older dying from this disease. Secondary preventive measures, including lifestyle modification and pharmacotherapy, are important for elderly patients because of the variable...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics