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ALLHAT: still providing correct answers after 7 years
Paula T Einhorn1, Barry R Davis, Jackson T Wright
1National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
Current Opinion in Cardiology
|June 4, 2010
Summary
Thiazide diuretics are the preferred first-line treatment for hypertension, demonstrating superiority in preventing major cardiovascular events and heart failure across diverse patient groups, including Black individuals and those with kidney disease.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Pharmacology
Background:
- The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) provided pivotal data on hypertension management.
- Recent analyses offer deeper insights into specific patient subgroups and drug effects.
Purpose of the Study:
- Re-evaluate ALLHAT findings with updated data from subgroup analyses, new trials, and meta-analyses.
- Focus on heart failure, outcomes in Black patients and those with chronic kidney disease, diuretic selection, and new-onset diabetes.
Main Methods:
- Review of ALLHAT data, subgroup analyses, and meta-analyses.
- Comparative effectiveness analysis of thiazide diuretics versus other antihypertensives (ACEIs, CCBs, alpha-blockers).
Main Results:
- Thiazide diuretics confirmed superior in preventing major cardiovascular outcomes, including heart failure and stroke.
- Evidence strengthened for patients with diabetes, renal disease, metabolic syndrome, and particularly Black patients.
- Thiazides showed superiority in preventing heart failure with preserved ejection fraction and were comparable to ACEIs for impaired ejection fraction.
- No increased cardiovascular risk observed with thiazide-induced new-onset diabetes.
Conclusions:
- Thiazide diuretics, at evidence-based doses, remain the preferred first-step therapy for most hypertensive patients.
- The findings reaffirm the initial ALLHAT conclusions with robust supporting evidence.
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