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Doxazosin was associated with more stroke and cardiovascular disease events than chlorthalidone in high risk hypertension

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 QUESTION: In high risk hypertensive patients, is doxazosin (an α-adrenergic blocker) or chlorthalidone (a diuretic) more effective in reducing cardiovascular disease (CVD) events?


Randomised (allocation concealed*), blinded (clinicians and patients),* controlled trial with median 3.3 year follow up.


625 centres in the US and Canada.


24 335 patients who were ≥55 years of age (mean age 67 y, 53% men, 49% white non-Hispanic), had systolic blood pressure (BP) ≥140 mm Hg or diastolic BP ≥90 mm Hg, took medication for hypertension, and had ≥1 other risk factor for coronary heart disease (CHD). {Exclusion criteria included myocardial infarction (MI), stroke, or angina pectoris in the past 6 months; congestive heart failure (CHF) or ejection fraction <35%; or serum creatinine concentration ≥177 μmol/l.} 97% of patients were included in the analysis.


Patients were allocated …

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  • Sources of funding: National Heart, Lung, and Blood Institute and Pfizer. Medication supplied by Pfizer Inc, AstraZeneca, and Bristol-Myers Squibb.

  • For correspondence: Dr B R Davis, University of Texas-Houston, School of Public Health, 1200 Herman Pressler Street, Houston, TX 77030, USA. Fax +1 713 500 9530.

  • * See glossary.

  • Davis BR, Cutler JA, Gordon DJ, et al. Am J Hypertens 1996;9:342–60.