ALLHAT

Trial Details

Acronym: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial

Purpose: Evaluated chlorthalidone versus amlodipine versus lisinopril in patients with hypertension and coronary risk factors

Format: Randomized, double-blind, active-controlled

Treatment Group 1: chlorthalidone, 12.5 to 25 mg/d  

Treatment Group 2: amlodipine, 2.5 to 10 mg/d

Treatment Group 3: lisinopril, 10 to 40 mg/d

Number of Patients: 33,357

Inclusion Criteria:

• 55 years or older
• Hypertension
• At least 1 other CHD risk factor

Primary Endpoint: composite endpoint of fatal coronary heart disease or nonfatal MI

Secondary Endpoints:

• All-cause mortality
• Stroke
• Combined CHD (primary outcome, coronary revascularization, or angina with hospitalization)
• Combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure, and peripheral arterial disease)

Follow-up: Mean, 4.9 years

Summary:

The primary composite endpoint of fatal coronary heart disease or nonfatal MI was similar in the three groups. Chlorthalidone improved blood pressure the best, reduced stroke, cardiovascular disease and heart failure better than lisinopril, and reduced heart failure diagnosis better than amlodipine. Only 30% of patients achieved goal blood pressure control on one agent. There was a doxazosin arm which was stopped early due to an increase in the primary endpoint and twice the risk of developing heart failure versus chlorthalidone. A subgroup evaluated pravastatin 40 mg PO daily which did not show any mortality benefit despite lowering LDL cholesterol levels (small study).

Original Publication:

Furberg CD, et al. JAMA. 2002; doi:10.1001/jama.288.23.2981.