Published in , the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) sought to determine which of. Request PDF on ResearchGate | On Jul 1, , José Ramón González- Juanatey and others published Después del estudio ALLHAT, ¿qué sabemos de lo que. Después del estudio ALLHAT, ¿qué sabemos de lo que desconocíamos sobre el and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
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Secondary outcomes were all-cause mortality, stroke, combined CHD primary outcome, coronary revascularization, or angina with hospitalizationand combined CVD combined CHD, stroke, treated angina without hospitalization, heart failure [HF], and peripheral arterial disease. No statistically significant differences were observed.
Individuals were censored for outcomes if they died, had no outcome in the database by the end of the study, or were lost to follow-up.
The defense of the preeminence of diuretics does not sufficiently emphasize that patients treated with chlorthalidone presented a significantly higher incidence of hypokalemia, hyperglycemia, hypercholesterolemia, increased creatinine or new diagnosis of diabetes. Thiazide for the postponement of postmenopausal bone loss. Several clinical studies suggest lower fracture risk with their use, 1011 although not all studies agree.
The mean follow-up was 4. Hiroshima J Med Sci.
Design and Conclusions of the ALLHAT Study
Risk of falls associated with antihypertensive medication: The VA data files were not available for the posttrial follow-up ; therefore, the posttrial cohort was limited to US citizens with Medicare Part A insurance at randomization Figure 1. This study has important strengths. Five-year systolic blood pressures were significantly higher in the etsudio 0.
The in-trial and the in-trial plus posttrial results 1 year after randomization Figure 2 C and D were similar to the in-trial and in-trial plus posttrial results from the time of randomization Figure 2 A and B.
This has largely to do with such things as drug cost, availability, side-effect profile, and the assumption that the benefits of chlorthalidone represent a class effect among thiazides. J Bone Miner Metab.
For amlodipine vs chlorthalidone, secondary outcomes were similar except for a higher 6-year rate of HF with amlodipine Views Read View source View history. For lisinopril vs chlorthalidone, lisinopril had higher 6-year rates of combined CVD Iberoamerican Cardiovascular Journals Editors’ Network. Back to top Article Information. Similar results were noted after adjustment for demographic and clinical variables HR, 0. The doxazosin arm was terminated prematurely because of a significantly increased risk of HF compared to chlorthalidone noted during an interim analysis.
Data are summarized as means SDs for continuous variables and numbers percentages of study participants for categorical variables. Register for email alerts with links to free full-text articles Access PDFs of free articles Manage your interests Save searches and receive search alerts.
Despite these caveats, participants randomized to receive chlorthalidone during the in-trial period continued to have a lower point estimate of fracture risk 5 years after study completion, suggesting but not proving a legacy effect. The optimal choice of antihypertensive for prevention of CAD endpoints was unclear. Given these results and the widespread use of ACEis for the treatment of hypertension in older adults, our finding has potentially important public health implications.
The unadjusted HR for atenolol users was 1. In unadjusted analyses, participants randomized to receive chlorthalidone had significantly decreased risk HR, 0. Likewise, all-cause mortality did not differ between groups.
ALLHAT – Wiki Journal Club
During the in-trial period mean [SD] follow-up, 3. Zllhat conditions are interrelated because people with hypertension have more osteoporotic fractures than people without hypertension.
Kara Elam, MS, The University of Texas School of Public Health, provided early editorial assistance in the preparation of the manuscript and was compensated for her work as an employee of the Coordinating Center. The study population is at high cardiovascular risk and aged over 55 years, so whether the same effects would arise in a lower risk population is mere conjecture.
However, a higher risk of fracture or lower BMD in ACEi users has not been a universal finding, and some studies 1011 report a protective effect of renin angiotensin blockade.
Similar trends were found when chlorthalidone use was compared with lisinopril or amlodipine use separately eFigure 1 in the Supplement. Previous Article Vol Second, participation in ALLHAT excluded several groups of participants at high risk for fracture, such as those with active coronary artery disease and heart failure 1028 and chronic kidney disease. Interaction terms were not statistically significant with P values ranging from.
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In all instances, use of chlorthalidone was associated with a lower risk of fracture than amlodipine or lisinopril. Sign in to access your subscriptions Sign in to your personal account. Although randomization is not strictly maintained with this approach, this was done for 2 reasons: Copyright American Medical Association.
The large sample size, long follow-up, and randomized therapy provide a unique opportunity to examine post hoc the effects of the major classes of blood pressure—lowering medications on the incidence of hospitalizations for hip and pelvic fractures. Protective effects of amlodipine and lacidipine on ovariectomy-induced bone loss in rats. Study weaknesses should also be acknowledged. No significant difference was found between those taking or not taking atenolol.
But such a reduction is to be expected because we can assume that the incidence of such events would be greater in a group receiving no treatment than in one receiving treatment. During the entire trial and posttrial period of follow-up, the cumulative incidence of fractures was nonsignificantly lower in participants randomized to receive chlorthalidone vs lisinopril or amlodipine HR, 0.