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In Reply: Dr Chikamori suggests that the high prevalence of atherosclerotic cardiovascular disease and baseline left ventricular (LV) dysfunction may be responsible for the difference in heart failure between the chlorthalidone and both the lisinopril and amlodipine arms of ALLHAT. The prevalence of atherosclerotic disease (52%) observed in ALLHAT, although higher than in the trials he indicates, was less than that in the The Heart Outcomes Prevention Evaluation Study Investigators (HOPE) trial (80%).¹ Assessment of LV function was not required at baseline in ALLHAT. However, hypertensive patients with a history of heart failure or measured LV ejection fraction of less than 35% were excluded from the trial.

Dr Houghton's hypothesis that the conclusions from ALLHAT may relate only to those with salt-sensitive hypertension is interesting, although not directly evaluated in our study. Diuretic-based therapy has demonstrated benefit in multiple subgroups of patients.² In fact, the largest body of evidence in . . . [Full Text of this Article]

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Information from drug companies and opinion leaders
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