Published in , the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) sought to determine which of. Request PDF on ResearchGate | On Jul 1, , José Ramón González- Juanatey and others published Después del estudio ALLHAT, ¿qué sabemos de lo que. Después del estudio ALLHAT, ¿qué sabemos de lo que desconocíamos sobre el and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
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The VA data files were not available for the posttrial follow-up ; therefore, the posttrial cohort was limited to US citizens with Medicare Part A insurance at sllhat Figure 1. The mean SD follow-up was 4. Moreover, during the posttrial period, the choice of blood pressure medication was no longer constrained by the study protocol; therefore, lalhat originally randomized to receive chlorthalidone might have stopped using this medication and nonchlorthalidone users might have begun to take a thiazide diuretic.
If the aim is to test the superiority of one treatment over another, and the results show no difference, can the authors conclude that diuretics are preferable? Study weaknesses should also be acknowledged.
Because participants who were already taking atenolol at baseline were allowed to continue to take atenolol and atenolol was a step 2 allhhat, participants taking atenolol at the first follow-up visit 1 month were assumed to be taking atenolol at baseline.
Design and Conclusions of the ALLHAT Study | Revista Española de Cardiología (English Edition)
Special recognition is due to 3 ALLHAT leaders who died after making very significant contributions to initiating the trial and overseeing most of its course: The step 1 study medications chlorthalidone, They should be preferred for first-step antihypertensive therapy.
In all instances, use of chlorthalidone was associated with a lower risk of fracture than amlodipine or lisinopril. This finding was consistent in all subgroup comparisons. This has largely to do with such things as drug cost, availability, estuio profile, and the assumption that the benefits of chlorthalidone represent a class effect among thiazides.
In the cohort with in-trial and posttrial follow-up, 69 pelvic and hip fractures occurred during the in-trial and posttrial periods. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT was a large randomized clinical trial that compared the effect of first-step therapy with different classes of antihypertensive drug therapy in preventing fatal coronary heart disease CHD or nonfatal myocardial infarction primary outcome and other cardiovascular disease CVD events.
We should point out that the incidence of coronary events in all alohat is greater than expected. Estudko authors’ argument that this does not influence coronary events may be fallacious because the follow-up is too short for this influence to become apparent. No other disclosures were reported. The conditions are interrelated because people with hypertension have more osteoporotic fractures than people without hypertension.
A positive effect on calcium balance and a direct stimulatory effect on osteoblasts have been proposed as the biological basis for this putative beneficial effect. Heterogeneity was assessed for age, race, sex, diabetes, eGFR, incident and prevalent CVD, body mass index, smoking, and for females hormone replacement therapy.
Initial curves for allha in-trial A and in-trial plus posttrial B cohorts and curves from year 1 onward after randomization for the in-trial C and in-trial plus posttrial D cohorts. J Clin Hypertens Greenwich. Medications supplied by Pfizer amlodipine, doxazosinAstraZeneca atenolol, lisinopril and Bristol-Myers Squibb pravastatin.
Design and Conclusions of the ALLHAT Study
Sign in to save your search Sign in to your personal account. Such ascertainment results in less underestimation of hip fracture incidence than methods based on self-report.
October Next article. The fracture rates were somewhat higher than in the in-trial cohort, likely because of the older age of the cohort with extended follow-up. Second, analyses that included in-trial and posttrial follow-up yielded a fracture risk that was no longer significantly different between the treatment groups, albeit it was still numerically lowest in the chlorthalidone group.
Participants younger than 65 years allhst randomization enrolled by non-VA clinics and participants from Canada were not included because they would not have had continuous coverage in either data source. In patients with hypertension, chlorthalidone, amlodipine, and estydio performed similarly in regards to fatal CAD and nonfatal MI.
Retrieved from ” http: Thiazide diuretics and the risk for hip fracture. J Bone Miner Res.
Data from randomized clinical trials are lacking. Correct interpretation of a trial should be based on the question that it was designed to answer.
For estrogen, analyses are for women only. Hiroshima J Med Sci.
ALLHAT – Wiki Journal Club
To our knowledge, this analysis provides the first randomized comparison of different antihypertensive medications on risk of hip or pelvic fractures. Comparisons are chlorthalidone vs.
Surprisingly, the authors then conclude that thiazide diuretics should be the initial treatment in arterial hypertension zllhat should be used, if possible, in association with antihypertensive agents.
Given these results and the widespread use of ACEis for the treatment of hypertension in older adults, our finding has potentially important public health implications.