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Titolo:
Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone - The Antihypertensive and Lipid-Lowering Treatment toPrevent Heart Attack Trial (ALLHAT)
Autore:
Furberg, CD; Wright, JT; Davis, BR; Cutler, JA; Alderman, M; Black, H; Cushman, W; Grimm, R; Haywood, LJ; Leenen, F; Oparil, S; Perry, HM; Probstfield, J; Whelton, P; Payne, G; Nwachuku, C; Gordon, D; Proschan, M; Frommer, P; Einhorn, P; Hawkins, M; Ford, C; Pressel, S; Piller, L; Lusk, C; Bettencourt, J; Kimmel, B; Geraci, T; Walsh, S; Rahman, M; Juratovac, A; Pospisil, R; Brennan, K; Carroll, L; Sullivan, S; Barone, G; Christian, R; Feldman, S; Lucente, T; Lewis, CE; Jenkins, K; McDowell, P; Johnson, J; Kingry, C; Letterer, R; Margolis, K; Holland, L; Jaeger-Fox, B; Williamson, J; Louis, G; Ragusa, P; Williard, A; Ferguson, RS; Tanner, J; Eckfeldt, J; Crow, R; Pelosi, J;
Indirizzi:
Univ Texas, Sch Publ Hlth, Houston, TX 77030 USA Univ Texas Houston TX USA 77030 xas, Sch Publ Hlth, Houston, TX 77030 USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 15, volume: 283, anno: 2000,
pagine: 1967 - 1975
SICI:
0098-7484(20000419)283:15<1967:MCEIHP>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
LEFT-VENTRICULAR MASS; THERAPY; FAILURE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
23
Recensione:
Indirizzi per estratti:
Indirizzo: Davis, BR Univ Texas, Sch Publ Hlth, 1200 Herman Pressler St, Houston, TX 77030 USA Univ Texas 1200 Herman Pressler St Houston TX USA 77030 7030 USA
Citazione:
C.D. Furberg et al., "Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone - The Antihypertensive and Lipid-Lowering Treatment toPrevent Heart Attack Trial (ALLHAT)", J AM MED A, 283(15), 2000, pp. 1967-1975

Abstract

Context Hypertension is associated with a significantly increased risk of morbidity and mortality. Only diuretics and beta-blockers have been shown to reduce this risk in long-term clinical trials: Whether newer antihypertensive agents reduce the incidence of cardiovascular disease (CVD) is unknown. Objective To compare the effect of doxazosin, an alpha-blocker, with chlorthalidone, a diuretic, on incidence of CVD in patients with hypertension aspart of a study of 4 types of antihypertensive drugs: chlorthalidone, doxazosin, amlodipine, and lisinopril. 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 A total of 24335 patients (aged greater than or equal to 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor who received either doxazosin or chlorthialidone. Interventions Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n = 15268), or doxazosin, 2 to 8 mg/d (n = 9067), for aplanned follow-up of 4 to 8 years. Main Outcome Measures The primary outcome measure was fatal CHD or nonfatal myocardial infarction.(MI), analyzed by intent to treat; secondary outcome measures included all-cause mortality, stroke, and combined CVD (CHD death, nonfatal MI, stroke, angina, coronary revascularization, congestive heart failure [CHF], and peripheral arterial disease); com pared by the chlorthalidone group vs the doxazosin group. 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 19/09/20 alle ore 08:22:29