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To the Editor: The authors of The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)¹ reported that lisinopril, amlodipine, and chlorthalidone were associated with similar 5-year risks of cardiac death or nonfatal myocardial infarction among patients with hypertension. However, chlorthalidone was more effective than lisinopril or amlodipine in preventing the development of heart failure. Chlorthalidone was also more effective than lisinopril in preventing combined coronary vascular disease (CVD) and stroke.

One of the unique features of ALLHAT is its sample of high-risk patients; more than half the patients had preexisting atherosclerotic CVD. This prevalence is considerably higher than in other recent clinical trials of hypertension such as Systolic Hypertension in the Elderly Program (SHEP), Systolic Hypertension in Europe (Syst-Eur) study, Swedish Trial in Old Patients with Hypertension-2 (STOP Hypertension-2), and Losartan Intervention For Endpoint reduction in hypertension study (LIFE).^2-5

In patients with known CVD, one of the most . . . [Full Text of this Article]

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Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group
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