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Comments on ALLHAT and doxazosin.

Lawrence R Krakoff¹

¹Englewood Hospital and Medical Center, Englewood, New Jersey, USA. Lawrence.Krakoff@ehmc.com

Current Controlled Trials in Cardiovascular Medicine

|January 25, 2002

Summary

The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found doxazosin inferior to diuretics for high-risk patients. These findings underscore the importance of widely disseminating ALLHAT results to guide clinical practice.

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Area of Science:

Cardiovascular Medicine
Clinical Trials
Pharmacology

Background:

The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) investigated treatments for cardiovascular disease.
Previous treatment guidelines may not have adequately reflected the comparative effectiveness of different antihypertensive medications.

Purpose of the Study:

To summarize the rationale, design, and initial results of the ALLHAT trial.
To provide a historical perspective on the response to ALLHAT, including legal and regulatory actions.
To emphasize the clinical implications of the ALLHAT findings regarding initial antihypertensive therapy.

Main Methods:

The ALLHAT trial involved a large cohort of patients at high risk for cardiovascular disease.
Comparative effectiveness of different antihypertensive drug classes was assessed.
Initial results and subsequent analyses informed the study's conclusions.

Main Results:

Initial therapy with doxazosin was found to be inferior to low-dose diuretic treatment.
This inferiority was particularly noted in patients at high risk for cardiovascular events.
The results suggest a need to re-evaluate standard treatment protocols.

Conclusions:

The results of the ALLHAT trial warrant wide dissemination among healthcare professionals.
Clinicians should be cautioned against using doxazosin as initial therapy for high-risk cardiovascular patients.
Low-dose diuretic treatment is a superior initial option for this patient population.

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