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Amlodipine or lisinopril was not better than chlorthalidone in lowering CHD risk in hypertension

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 QUESTION: In predominately older patients with hypertension and ≥1 other coronary heart disease (CHD) risk factor, is amlodipine or lisinopril better than chlorthalidone in lowering the risk for CHD or other cardiovascular disease (CVD) events?


Randomised (allocation concealed*), blinded {patients, clinicians, data collectors, outcome assessors, and steering committee},* controlled trial with mean 4.9 years of follow up (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial [ALLHAT]).


623 centres in the US, Canada, Puerto Rico, and the US Virgin Islands.


33 357 patients ≥55 years of age (mean age 67 y, 53% men) who had stage 1 or stage 2 hypertension and ≥1 additional risk factor for CHD. The risk factors were myocardial infarction (MI) or stroke in the previous 6 months, left ventricular hypertrophy, type 2 diabetes, smoking, high density lipoprotein cholesterol <0.91 mmol/l, or other atherosclerotic CVD. Patients with a history of heart failure (HF) or known left ventricular ejection fraction <35% were excluded. Follow up was 97%; all randomised …

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

  • For correspondence: Dr J T Wright, Case Western Reserve University, Cleveland, OH, USA. jxw20{at}; Dr B R Davis, University of Texas-Houston Health Science Center, Houston, TX, USA. bdavis{at}

  • Abstracts and commentary also appear in ACP Journal Club.

  • * See glossary.

  • Information provided by author.