Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Published comments/rapid response letters    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  PubMed Articles in PubMed by Author:    Davis, B. R.    Related Articles in PubMed    PubMed Citation    PubMed

PERSPECTIVE

ALLHAT: Setting the Record Straight

Barry R. Davis, MD, PhD; Curt D. Furberg, MD, PhD; Jackson T. Wright, Jr., MD, PhD; Jeffrey A. Cutler, MD, MPH; Paul Whelton, MD, MSc, the ALLHAT Collaborative Research Group

6 July 2004 | Volume 141 Issue 1 | Pages 39-46

The findings of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have generated worldwide reaction from clinicians and researchers, including a recent commentary in this journal. Such response was expected for a trial of ALLHAT's size and scope, especially since its results challenged some widely held beliefs. This paper reviews key aspects of the ALLHAT design, analyses, findings, and conclusions to provide a perspective on the commentary about the trial's results and implications for clinical practice. Several of the most frequent comments regarding the study's results are addressed, particularly with respect to heart failure and diabetes outcomes. Responses to these comments reinforce the investigators' original conclusion that thiazide-type diuretics should remain the preferred first-step drug class for treating hypertension and should generally be a part of any multidrug regimen.

Author and Article Information

From The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas; Wake Forest University School of Medicine, Winston-Salem, North Carolina; Case Western Reserve University, Cleveland, Ohio; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and Tulane University Health Sciences Center, New Orleans, Louisiana.

Grant Support: By the National Heart, Lung, and Blood Institute (contract N01-HC-35130). The ALLHAT investigators received study medications from Pfizer (amlodipine and doxazosin), AstraZeneca (atenolol and lisinopril), and Bristol-Myers Squibb (pravastatin) and financial support from Pfizer.

Potential Financial Conflicts of Interest:Consultancies: J.T. Wright Jr. (Astra, Aventis, Bayer, Bristol-Myers Squibb, Merck & Co., Novartis Pharma AG, Pfizer, Phoenix Pharmaceuticals, Searle & Co., SmithKline Beecham, Solvay/Unimed); Honoraria: B.R. Davis (Pfizer), J.T. Wright Jr. (Astra, Aventis, Bayer, Bristol-Myers Squibb, Merck & Co., Novartis Pharma AG, Pfizer, Phoenix Pharmaceuticals, Searle & Co., SmithKline Beecham, Solvay/Unimed), P. Whelton (Pfizer); Grants received: J.T. Wright Jr. (Astra, Aventis, Bayer, Bristol-Myers Squibb, Eli Lilly & Co., Merck & Co., Novartis Pharma AG, Pfizer, Searle & Co., SmithKline Beecham, Solvay/Unimed); J.A. Cutler (Pfizer, AstraZeneca, Bristol-Myers Squibb).

Requests for Single Reprints: Barry R. Davis, MD, PhD, The University of Texas Health Science Center at Houston School of Public Health, 1200 Herman Pressler Street, Suite E801, Houston, TX 77030; e-mail, bdavis{at}sph.uth.tmc.edu.

Current Author Addresses: Dr. Davis: The University of Texas Health Science Center at Houston School of Public Health, 1200 Herman Pressler Street, Suite E801, Houston, TX 77030.

Dr. Furberg: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 57157-1063.

Dr. Wright: Case Western Reserve University, General Clinical Research Center, Horvitz Tower, Suite 7311, 11100 Euclid Avenue, Cleveland, OH 44106-5041.

Dr. Cutler: National Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical Applications, 6701 Rockledge Drive, Room 8130, Bethesda, MD 20892-7936.

Dr. Whelton: Tulane University Health Sciences Center, 1440 Canal Street TW-5, Suite 2400, New Orleans, LA 70112.

Related articles in Annals:

Editorials
Publishing Commentary by Authors with Potential Conflicts of Interest: When, Why, and How
The Editors

Annals 2004 141: 73-74. [Full Text]  

Letters
ALLHAT, or the Soft Science of the Secondary End Point
David B. Neely

Annals 2004 141: 77. [Full Text]  

Letters
Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy
Mori J. Krantz AND Philip S. Mehler

Annals 2004 141: 893. [Full Text]  

Letters
Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy
Barry R. Davis, Curt D. Furberg, Jackson T. Wright, Jr., Jeffrey A. Cutler, AND Paul Whelton

Annals 2004 141: 893. [Full Text]  

This article has been cited by other articles:

				T. L. Reudelhuber, K. E. Bernstein, and P. Delafontaine Is Angiotensin II a Direct Mediator of Left Ventricular Hypertrophy?: Time for Another Look Hypertension, June 1, 2007; 49(6): 1196 - 1201. [Full Text] [PDF]

				B. R. Davis, L. B. Piller, K. Dunn, J. A. Cutler, M. Proschan, C. Furberg, D. Goff, S. Franklin, F. Leenen, S. Mohiuddin, et al. Response to Letter Regarding Article, "Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)" Circulation, January 16, 2007; 115(2): e19 - e19. [Full Text] [PDF]

				A. J. Zillich, J. Garg, S. Basu, G. L. Bakris, and B. L. Carter Thiazide Diuretics, Potassium, and the Development of Diabetes: A Quantitative Review Hypertension, August 1, 2006; 48(2): 219 - 224. [Abstract] [Full Text] [PDF]

				A. J. Zillich and S. T. Haines ASHP Therapeutic Position Statement on the Treatment of Hypertension. Am. J. Health Syst. Pharm., June 1, 2006; 63(11): 1074 - 1080. [Full Text] [PDF]

				A. Salvetti and L. Ghiadoni Thiazide Diuretics in the Treatment of Hypertension: An Update J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S25 - S29. [Abstract] [Full Text] [PDF]

				M. E. Ernst, B. L. Carter, C. J. Goerdt, J. J.G. Steffensmeier, B. B. Phillips, M. B. Zimmerman, and G. R. Bergus Comparative Antihypertensive Effects of Hydrochlorothiazide and Chlorthalidone on Ambulatory and Office Blood Pressure Hypertension, March 1, 2006; 47(3): 352 - 358. [Abstract] [Full Text] [PDF]

				A. S. Levey and K. Uhlig Which Antihypertensive Agents in Chronic Kidney Disease? Ann Intern Med, February 7, 2006; 144(3): 213 - 215. [Full Text] [PDF]

				T. H. Jafar, S. Jessani, F. H. Jafary, M. Ishaq, R. Orkazai, S. Orkazai, A. S. Levey, and N. Chaturvedi General Practitioners' Approach to Hypertension in Urban Pakistan: Disturbing Trends in Practice Circulation, March 15, 2005; 111(10): 1278 - 1283. [Abstract] [Full Text] [PDF]

				M. J. Krantz and P. S. Mehler Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy Ann Intern Med, December 7, 2004; 141(11): 893 - 893. [Full Text] [PDF]

				F. H.H. Leenen ALLHAT: What has it taught us so far? Can. Med. Assoc. J., September 28, 2004; 171(7): 719 - 720. [Full Text] [PDF]

				The Editors Publishing Commentary by Authors with Potential Conflicts of Interest: When, Why, and How Ann Intern Med, July 6, 2004; 141(1): 73 - 74. [Full Text] [PDF]

Rapid Responses: