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ALLHAT, or the soft science of the secondary end point

Franz H Messerli1

  • 1Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA. fmesserli@aol.com

Annals of Internal Medicine
|November 5, 2003
PubMed

Insights

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial found no difference in coronary heart disease between chlorthalidone, lisinopril, and amlodipine. Conclusions favoring thiazide diuretics were based on secondary outcomes, not primary data.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a significant study in cardiovascular disease research.
  • Previous interpretations of ALLHAT have influenced hypertension treatment guidelines, notably the Seventh Report of the Joint National Committee (JNC 7).

Purpose of the Study:

  • To critically evaluate the conclusions drawn from the ALLHAT trial regarding antihypertensive drug classes.
  • To assess the validity of prioritizing thiazide diuretics for first-line hypertension therapy based on ALLHAT's findings.

Main Methods:

  • Analysis of primary and secondary end points from the ALLHAT trial.
  • Review of the evidence used to support recommendations in hypertension treatment guidelines.

Main Results:

  • The primary end point, coronary heart disease, showed no significant difference between chlorthalidone, lisinopril, and amlodipine groups.
  • Conclusions favoring thiazide diuretics were based on secondary end points and cost-effectiveness analyses, not primary outcome data.

Conclusions:

  • The reliance on secondary end points in ALLHAT for major conclusions is questionable.
  • Thiazide diuretics remain important in hypertension management, but should not be exclusively preferred based on this interpretation of ALLHAT.
  • Further consideration of 'soft data' in clinical trial interpretation is warranted for evidence-based hypertension therapy.

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