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  • Diuretics were superior to calcium channel blockers and short term ACE inhibitors for reducing heart failure in hypertension

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Therapeutics
Diuretics were superior to calcium channel blockers and short term ACE inhibitors for reducing heart failure in hypertension

https://doi.org/10.1136/ebm.12.1.17

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    Davis BR, Piller LB, Cutler JA, et al. Role of diuretics in the prevention of heart failure: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Circulation 2006;113:2201–10.

    
 
 Q In high risk patients with hypertension, what is the effect of chlorthalidone, amlodipine, and lisinopril on hospitalised or fatal heart failure (HF)? Does the effect differ across time and prespecified subgroups?

    Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★★ Cardiology ★★★★★★☆

    METHODS

    Embedded ImageDesign:

    randomised controlled trial (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial [ALLHAT]).

    Embedded ImageAllocation:

    {concealed*}†.

    Embedded ImageBlinding:

    blinded {patients, clinicians, data collectors, outcome assessors, and investigators}‡.*

    Embedded ImageFollow-up period:

    mean 4.9 years.

    Embedded ImageSetting

    {623 centers in the US, Canada, Puerto Rico, and the US Virgin Islands.}†

    Embedded ImagePatients

    33 357 patients who were ⩾55 years of age (mean age 67 y, 53% men) and had stage 1 or 2 hypertension plus an additional risk factor for coronary artery disease. Exclusion criteria were history of hospitalised or symptomatic HF or known left ventricular …

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    Footnotes

    • ↵* See glossary.

    • ↵†

      ALLHAT. JAMA 2002;288:2981–97.
      OpenUrlCrossRefPubMedWeb of Science

    • ↵‡ Information provided by author

    • For correspondence: Dr B R Davis, University of Texas School of Public Health, Houston, TX, USA. barry.r.davis{at}uth.tmc.edu

    • Sources of funding: National Heart, Lung, and Blood Institute and Pfizer Inc.

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      BMJ Evidence-Based Medicine 2007; 12 31-32 Published Online First: 30 Jan 2007. doi: 10.1136/ebm.12.1.31