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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Researchers showed that heart failure occurred more often in hypertensive patients taking an
SUMMARIES FOR PATIENTS
Blood Pressure Drugs and Heart Failure
3 September 2002 | Volume 137 Issue 5 Part 1 | Page I-38
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "Relationship of Antihypertensive Treatment Regimens and Change in Blood Pressure to Risk for Heart Failure in Hypertensive Patients Randomly Assigned to Doxazosin or Chlorthalidone: Further Analyses from the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial." It is in the 3 September 2002 issue of Annals of Internal Medicine (volume 137, pages 313-320). The authors are BR Davis, JA Cutler, CD Furberg, JT Wright Jr., MA Farber, JV Felicetta, and JD Stokes, for the ALLHAT Collaborative Research Group.
What is the problem and what is known about it so far?
High blood pressure (hypertension) is a chronic condition that damages blood vessels and body organs. It increases the risk for heart attacks, heart failure, strokes, and kidney failure. Although the many types of drugs used to treat hypertension may reduce blood pressure by a similar amount, their ability to prevent complications of hypertension may vary. Also, different drugs cause different side effects. 
-blocker (doxazosin) than a diuretic (chlorthalidone). However, the -blocker reduced blood pressure slightly less than the diuretic. Patients taking the -blocker also used more drugs (different types) to help reduce their blood pressure. Thus, it was difficult to sort out whether the heart failure was due to the -blocker itself, the additional drugs, or the higher blood pressure in patients taking the -blocker.
Why did the researchers do this particular study?
To compare heart failure outcomes among adults with high blood pressure who were taking a diuretic (chlorthalidone) or an -blocker (doxazosin).
Who was studied?
24,005 adults older than age 55 years who had high blood pressure and at least one other risk factor for heart disease (prior heart attack, stroke, diabetes, smoking, cholesterol problems, or an enlarged heart).
How was the study done?
Patients were randomly assigned to take doxazosin or chlorthalidone. Both drugs were given once a day in the morning. Neither the patients nor their doctors knew which drug the patients received. Blood pressure was taken every 1 to 3 months. If blood pressures were higher than 140/90 mm Hg, higher drug doses and/or additional drugs (different types) were given. For the 3 years that patients were followed, researchers checked for heart failure diagnoses. They then compared the frequency of heart failure in patients assigned to doxazosin or chlorthalidone. They examined whether differences between groups could be due to differences in blood pressure or additional drugs.
What did the researchers find?
Patients assigned to chlorthalidone had slightly better blood pressure control than those assigned to doxazosin. Fewer of them needed additional drugs for blood pressure control (59% vs. 68%). Heart failure occurred significantly more often in patients receiving doxazosin than in those receiving chlorthalidone, even after differences in blood pressure control and use of other drugs were considered. Risks for heart failure with doxazosin versus chlorthalidone were highest in patients receiving only those drugs and lowest in patients receiving additional drugs.
What were the limitations of the study?
The study cannot tell us whether doxazosin caused heart failure, whether chlorthalidone prevented heart failure, or some combination of both effects.
What are the implications of the study?
Worse blood pressure control with doxazosin versus chlorthalidone does not explain higher heart failure risks of doxazosin. Increased risks for heart failure with doxazosin versus chlorthalidone decrease but do not disappear when other antihypertensive drugs are used.
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  N. Chapman, C. L. Chang, B. Dahlof, P. S. Sever, H. Wedel, N. R. Poulter, and on behalf of the ASCOT Investigators Effect of Doxazosin Gastrointestinal Therapeutic System as Third-Line Antihypertensive Therapy on Blood Pressure and Lipids in the Anglo-Scandinavian Cardiac Outcomes Trial Circulation, July 1, 2008; 118(1): 42 - 48. [Abstract] [Full Text] [PDF]
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B. R. Davis, L. B. Piller, J. A. Cutler, C. Furberg, K. Dunn, S. Franklin, D. Goff, F. Leenen, S. Mohiuddin, V. Papademetriou, et al. Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Circulation, May 9, 2006; 113(18): 2201 - 2210. [Abstract] [Full Text] [PDF]
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