Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group.
Abstract | CONTEXT: OBJECTIVE: DESIGN: Randomized, double-blind, active-controlled clinical trial, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, initiated in February 1994. In January 2000, after an interim analysis, an independent data review committee recommended discontinuing the doxazosin treatment arm based on comparisons with chlorthalidone. Therefore, outcomes data presented herein reflect follow-up through December 1999. SETTING: A total of 625 centers in the United States and Canada. PARTICIPANTS: INTERVENTIONS: Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n=15,268), or doxazosin, 2 to 8 mg/d (n=9067), for a planned follow-up of 4 to 8 years. MAIN OUTCOME MEASURES: RESULTS: Median follow-up was 3.3 years. A total of 365 patients in the doxazosin group and 608 in the chlorthalidone group had fatal CHD or nonfatal MI, with no difference in risk between the groups (relative risk [RR], 1.03; 95% confidence interval [CI], 0.90-1.17; P=.71). Total mortality did not differ between the doxazosin and chlorthalidone arms (4-year rates, 9.62% and 9.08%, respectively; RR, 1.03; 95% CI, 0.90-1.15; P=.56.) The doxazosin arm, compared with the chlorthalidone arm, had a higher risk of stroke (RR, 1.19; 95% CI, 1.01-1.40; P=.04) and combined CVD (4-year rates, 25.45% vs 21.76%; RR, 1.25; 95% CI, 1.17-1.33; P<.001). Considered separately, CHF risk was doubled (4-year rates, 8.13% vs 4.45%; RR, 2.04; 95% CI, 1.79-2.32; P<.001); RRs for angina, coronary revascularization, and peripheral arterial disease were 1.16 (P<.001), 1.15 (P=.05), and 1.07 (P=.50), respectively. CONCLUSION: Our data indicate that compared with doxazosin, chlorthalidone yields essentially equal risk of CHD death/nonfatal MI but significantly reduces the risk of combined CVD events, particularly CHF, in high-risk hypertensive patients.
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Authors | |
Journal | JAMA
(JAMA)
Vol. 283
Issue 15
Pg. 1967-75
(Apr 19 2000)
ISSN: 0098-7484 [Print] United States |
PMID | 10789664
(Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Adrenergic alpha-Antagonists
- Anticholesteremic Agents
- Antihypertensive Agents
- Diuretics
- Amlodipine
- Lisinopril
- Doxazosin
- Chlorthalidone
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Topics |
- Adrenergic alpha-Antagonists
(therapeutic use)
- Aged
- Amlodipine
(therapeutic use)
- Anticholesteremic Agents
(therapeutic use)
- Antihypertensive Agents
(therapeutic use)
- Cardiovascular Diseases
(epidemiology, prevention & control)
- Chlorthalidone
(therapeutic use)
- Diuretics
(therapeutic use)
- Double-Blind Method
- Doxazosin
(therapeutic use)
- Female
- Humans
- Hypertension
(drug therapy)
- Lisinopril
(therapeutic use)
- Male
- Middle Aged
- Myocardial Infarction
(epidemiology, prevention & control)
- Proportional Hazards Models
- Risk
- Survival Analysis
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