This Week’s Question:
In December 2002, the long-anticipated results of the Antihypertensive
and Lipid Lowering to protect against Heart Attacks Trial (ALLHAT),
the largest hypertension clinical trial ever conducted, were presented
at a press conference organized by the National Heart, Lung, and Blood
Institute (NHLBI), which supported the study, and the formal presentation
of the trial results was simultaneously published in the December 18,
2002, issue of JAMA.[1]
Conducted in 42,418 patients, the 2 most important results of ALLHAT
that have had the largest impact
1. The results with the newer classes of antihypertensive agents were
"as good as" diuretic therapy for protection against the primary
endpoint of the study, prevention of ischemic coronary events.
2. What was the second important result that came out of the ALLHAT
Trial?
1.
Hypertension is almost impossible to control in a geographically disparate
and ethnically diverse population
2. We now must treat
Pre-Hypertension <120 SP or <80 DP and <130/80 for those with
diabetes
3. The current poor
global blood pressure control rates could be brought into compliance
with as few as 2 of the current classes of antihypertensive drugs in
at least two thirds of a geographically disparate and ethnically diverse
population
4. Systolic blood
pressure can be brought into compliance with guideline-mandated target
blood pressure levels with 1 or 2 drugs, but diastolic blood pressure
requires the addition of at least 2 further classes of antihypertensive
drugs
5. Blood pressure
varies with age and geographic location, but not with gender, socioeconomic
status, or religion
