ALLHAT (calcium channel blocker)
Trial question
Is amlodipine superior to chlorthalidone in high-risk patients with hypertension?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
47.0% female
53.0% male
N = 24303
24303 patients (11451 female, 12852 male)
Inclusion criteria: patients ≥ 55 years of age with hypertension and at least 1 other coronary artery disease risk factor
Key exclusion criteria: history of hospitalized or treated symptomatic HF and/or known LVEF < 35%
Interventions
N=9048 amlodipine (a dose of 2.5-10 mg/day)
N=15255 chlorthalidone (a dose of 12.5-25 mg/day)
Primary outcome
Rate of fatal coronary artery disease or nonfatal myocardial infarction within 6 years
11.3
11.5
11.5 %
8.6 %
5.8 %
2.9 %
0.0 %
Amlodipine
Chlorthalidone
No significant difference ↔
No significant difference in the rate of fatal coronary artery disease or nonfatal myocardial infarction within 6 years (11.3% vs. 11.5%; RR 0.98, 95% CI 0.9 to 1.07)
Secondary outcomes
No significant difference in the rate of death from all causes within 6 years (16.8% vs. 17.3%; RR 0.96, 96% CI 0.89 to 1.02)
No significant difference in the rate of coronary artery disease within 6 years (19.9% vs. 19.9%; RR 1, 95% CI 0.94 to 1.07)
No significant difference in the rate of stroke within 6 years (5.4% vs. 5.6%; RR 0.93, 95% CI 0.82 to 1.06)
Safety outcomes
No significant difference in hospitalization for gastrointestinal bleeding.
Conclusion
In patients ≥ 55 years of age with hypertension and at least 1 other coronary artery disease risk factor, amlodipine was not superior to chlorthalidone with respect to the rate of fatal coronary artery disease or nonfatal myocardial infarction within 6 years.
Reference
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002 Dec 18;288(23):2981-97.
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