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ALLHAT

ALLHAT. Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril * * Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608. ALLHAT. Randomized Design of ALLHAT BP Trial. 42,418 High-risk hypertensive patients. Consent / Randomize.

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ALLHAT

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  1. ALLHAT Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril**Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608.

  2. ALLHAT Randomized Design of ALLHAT BP Trial 42,418 High-risk hypertensive patients Consent / Randomize Amlodipine Chlorthalidone Doxazosin Lisinopril Follow until death or end of study (4-8 years, mean 4.9 years)

  3. ALLHAT Race Subgroup Analysis • ALLHAT reported no differences in the primary CHD outcome, but overall superiority of thiazide-type diuretic for first-step therapy of hypertension based on differences in secondary outcomes • The population of blacks with hypertension has the highest morbidity and mortality from hypertension of any population group in the U.S. • Race was a prespecified subgroup for ALLHAT

  4. ALLHAT Baseline Characteristics by Race(Chlorthalidone, Amlodipine, Lisinopril)

  5. ALLHAT Blood Pressure at 5 Yearsby Race * P < 0.005 compared to Chlorthalidone

  6. ALLHAT BP Results by Treatment Group by Race

  7. ALLHAT % on 3+ Antihypertensive Drugs by Randomized Group and Race at 5 Years

  8. ALLHAT BP Control (<140/90 mm Hg) and Mean BP by Randomized Group and Race at 5 Years 135/78 136/76 139/79 133/74 134/74 134/74

  9. ALLHAT Serum Potassium(mean mmol/l)by Treatment Group and Race

  10. ALLHAT Serum Cholesterol(mean mg/dl)by Treatment Group and Race

  11. ALLHAT Fasting Glucose(mean mg/dl)by Treatment Group and Race

  12. ALLHAT Fasting Glucose 126 mg/dlby Treatment Group and Race

  13. ALLHAT Black 1.01 (0.86 - 1.18) 0.97 (0.87 - 1.09) 1.03 (0.91 - 1.17) 1.06 (0.96 - 1.16) 0.93 (0.76 - 1.14) 1.15 (0.84 - 1.58) 1.46 (1.24 - 1.73) 1 2 0.50 Favors Chlorthalidone Favors Amlodipine Black vs. Non-Black Amlodipine/Chlorthalidone Relative Risk and 95% Confidence Intervals Non-Black 0.97 (0.87 - 1.08) 0.94 (0.87 - 1.03) 0.99 (0.92 - 1.07) 1.04 (0.97 - 1.10) 0.93 (0.79 - 1.10) 1.08 (0.79 - 1.48) 1.32 (1.17 - 1.49) 0.50 1 2 Favors Chlorthalidone Favors Amlodipine

  14. ALLHAT Non-Black 0.94 (0.85 - 1.05) 1.10 (0.94 - 1.28) 0.97 (0.89 - 1.06) 1.06 (0.95 - 1.18) 1.01 (0.93 - 1.09) 1.15 (1.02 - 1.30) 1.06 (1.00 - 1.13) 1.19 (1.09 - 1.30) 1.00 (0.85 - 1.17) 1.40 (1.17 - 1.68) 0.93 (0.67 - 1.30) 1.29 (0.94 - 1.75) 1.13 (1.00 - 1.28) 1.30 (1.10 - 1.54) 0.50 1 2 0.50 1 2 Favors Chlorthalidone Favors Lisinopril Black vs. Non-Black Lisinopril/Chlorthalidone Relative Risk and 95% Confidence Intervals Black Favors Chlorthalidone Favors Lisinopril

  15. ALLHAT 12 Chlorthalidone Amlodipine Lisinopril 8 Cumulative HF Rate, % 4 0 0 1 2 3 4 5 6 Years to HF Heart Failure Rate for Blacks by Treatment Group

  16. Heart Failure Rate for Non-Blacks By Treatment Group ALLHAT 12 Chlorthalidone Amlodipine Lisinopril 8 Cumulative HF Rate, % 4 0 0 1 2 3 4 5 6 Years to HF

  17. ALLHAT ANGIOEDEMA There were 3 cases (<0.1%) of angioedema in the amlodipine group (comparison to chlorthalidone not significant).

  18. ALLHAT Antihypertensive Trial:Implications • Diuretics should be the drug of choice for initial therapy of hypertension. The evidence for this recommendation is even stronger for Black hypertensive patients.. • For the patient who cannot take a diuretic (which should be an unusual circumstance), CCB’s and ACEI’s may be considered. However, in Black hypertensive patients, ACEI’s should be considered second-line therapy. • Most hypertensive patients require more than one drug. Diuretics should generally be part of the antihypertensive regimen. Lifestyle advice should also be provided.

  19. Extra Slides

  20. ALLHAT Blacks Amlodipine/Chlorthalidone Relative Risk and 95% Confidence Intervals 0.50 1 2 Favors Amlodipine Favors Chlorthalidone

  21. ALLHAT Blacks Lisinopril/Chlorthalidone Relative Risk and 95% Confidence Interval 0.50 1 2 Favors Lisinopril Favors Chlorthalidone

  22. ALLHAT Non-Blacks Amlodipine/Chlorthalidone Relative Risk and 95% Confidence Intervals 2 0.50 1 Favors Amlodipine Favors Chlorthalidone

  23. ALLHAT Non-Blacks Lisinopril/Chlorthalidone Relative Risk and 95% Confidence Intervals 0.50 1 2 Favors Lisinopril Favors Chlorthalidone

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