Amlodipine or lisinopril was not better than chlorthalidone for reducing CVD risk in hypertensive black or non-black patients

doi:10.1136/ebm.10.6.170

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Evidence-Based Medicine 2005;10:170; doi:10.1136/ebm.10.6.170
Copyright © 2005 by the BMJ Publishing Group Ltd.

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Therapeutics

Amlodipine or lisinopril was not better than chlorthalidone for reducing CVD risk in hypertensive black or non-black patients

Wright JT Jr, Dunn JK, Cutler JA, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA 2005;293:1595–608.[Abstract/Free Full Text]

Q In black or non-black patients with hypertension, is amlodipine or lisinopril better than chlorthalidone for reducing cardiovascular disease (CVD)?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ ${star}$ ${star}$ Cardiology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: African continental ancestry group • angiotensin converting enzyme inhibitors • antihypertensive agents • calcium channel blockers • cardiovascular diseases • diuretics (sulphamyl) • hypertension

The first 150 words of the full text of this article appear below.

METHODS
Design: randomised controlled trial (Antihypertensive and Lipid-loweringTreatment to Prevent Heart Attack Trial [ALLHAT]).

Allocation: concealed.^*

Blinding: blinded {clinicians, patients, data collectors, outcome assessors,and steering committee}.^*

Follow up period: mean 4.9 years.

Setting: 623 centres in the US, Canada, Puerto Rico, and the US VirginIslands.

Patients: 33 357 black and non-black patients $>=$ 55 years of age (mean age67 y, 35% black, 53% men overall, 54% women among blacks) whohad hypertension with $>=$ 1 additional risk factor for coronaryheart disease (CHD), including left ventricular [LV] hypertrophy,type 2 diabetes, current smoker, high density lipoprotein cholesterolconcentration <0.9 mmol/l (35 mg/dl), and myocardial infarction(MI) or stroke in the previous 6 months. Patients with treatedsymptomatic heart failure (HF) or LV ejection fraction <35%were excluded.

Intervention: chlorthalidone, 12.5–25 mg/day (n = 15 255); amlodipine,2.5–10 mg/day (n = 9048); or lisinopril, 10–40 mg/day(n = 9054).

. . . [Full text of this article]

Mark Rosenberg, MD, Meera Jain, MD

Providence Portland Medical Center, Portland, Oregon, USA