Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
« Previous Article | Table of Contents | Next Article »
Circulation. 2006;113:2201-2210
Published online before print May 1, 2006, doi: 10.1161/CIRCULATIONAHA.105.544031
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Data Supplement
Right arrow All Versions of this Article:
113/18/2201    most recent
CIRCULATIONAHA.105.544031v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Davis, B. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Davis, B. R.
Related Collections
Right arrow Clinical Studies
Right arrow Other heart failure
Right arrow Congestive
Right arrow Cardiovascular Pharmacology
Right arrowRelated Article

(Circulation. 2006;113:2201-2210.)
© 2006 American Heart Association, Inc.

Heart Failure

Role of Diuretics in the Prevention of Heart Failure

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Barry R. Davis, MD, PhD; Linda B. Piller, MD, MPH; Jeffrey A. Cutler, MD, MPH; Curt Furberg, MD, PhD; Kay Dunn, PhD; Stanley Franklin, MD; David Goff, MD, PhD; Frans Leenen, MD, PhD; Syed Mohiuddin, MD; Vasilios Papademetriou, MD; Michael Proschan, PhD; Allan Ellsworth, PharmD; John Golden, MD; Pedro Colon, MD; Richard Crow, MD, for the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Collaborative Research Group*

From the University of Texas School of Public Health (B.R.D., L.B.P., K.D.), Houston; National, Heart, Lung, and Blood Institute (J.A.C., M.P.), Bethesda, Md; Wake Forest University School of Medicine (C.F., D.G.), Winston-Salem, NC; University of California at Irvine (S.F.), Irvine; University of Ottawa Heart Institute (F.L.), Ottawa, Ontario, Canada; Creighton Cardiac Center (S.M.), Omaha, Neb; Veterans Affairs Medical Center (V.P.), Washington, DC; University of Washington (A.E.), Seattle; Penderbrook Medical Center (J.G.), Fairfax, Va; Centro Cardiovascular de Caguas (P.C.), Caguas, Puerto Rico; and University of Minnesota (R.C.), Minneapolis.

Correspondence to Barry R. Davis, MD, PhD, The University of Texas School of Public Health, 1200 Herman Pressler St, E-809, Houston, TX 77030. E-mail barry.r.davis{at}uth.tmc.edu

Received February 18, 2005; revision received February 24, 2006; accepted February 24, 2006.

Background— Hypertension is a major cause of heart failure (HF) and is antecedent in 91% of cases. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) stipulated assessment of the relative effect of chlorthalidone, lisinopril, and amlodipine in preventing HF.

Methods and Results— ALLHAT was a double-blind, randomized, clinical trial in 33 357 high-risk hypertensive patients aged ≥55 years. Hospitalized/fatal HF outcomes were examined with proportional-hazards models. Relative risks (95% confidence intervals; P values) of amlodipine or lisinopril versus chlorthalidone were 1.35 (1.21 to 1.50; <0.001) and 1.11 (0.99 to 1.24; 0.09). The proportional hazards assumption of constant relative risk over time was not valid. A more appropriate model showed relative risks of amlodipine or lisinopril versus chlorthalidone during year 1 were 2.22 (1.69 to 2.91; <0.001) and 2.08 (1.58 to 2.74; <0.001), and after year 1, 1.22 (1.08 to 1.38; P=0.001) and 0.96 (0.85 to 1.10; 0.58). There was no significant interaction between prior medication use and treatment. Baseline blood pressures were equivalent (146/84 mm Hg) and at year 1 were 137/79, 139/79, and 140/80 mm Hg in those given chlorthalidone, amlodipine, and lisinopril. At 1 year, use of added open-label atenolol, diuretics, angiotensin-converting enzyme inhibitors, and calcium channel blockers in the treatment groups was similar.

Conclusions— HF risk decreased with chlorthalidone versus amlodipine or lisinopril use during year 1. Subsequently, risk for those individuals taking chlorthalidone versus amlodipine remained decreased but less so, whereas it was equivalent to those given lisinopril. Prior medication use, follow-up blood pressures, and concomitant medications are unlikely to explain most of the HF differences. Diuretics are superior to calcium channel blockers and, at least in the short term, angiotensin-converting enzyme inhibitors in preventing HF in hypertensive individuals.

 

CLINICAL PERSPECTIVE


Related Article:

Issue Highlights
Circulation 2006 113: 2165. [Full Text]



This article has been cited by other articles:


Home page
 CirculationHome page
D. D. Schocken, E. J. Benjamin, G. C. Fonarow, H. M. Krumholz, D. Levy, G. A. Mensah, J. Narula, E. S. Shor, J. B. Young, and Y. Hong
Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group
Circulation, May 13, 2008; 117(19): 2544 - 2565.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
N. S. Beckett, R. Peters, A. E. Fletcher, J. A. Staessen, L. Liu, D. Dumitrascu, V. Stoyanovsky, R. L. Antikainen, Y. Nikitin, C. Anderson, et al.
Treatment of Hypertension in Patients 80 Years of Age or Older
N. Engl. J. Med., May 1, 2008; 358(18): 1887 - 1898.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
F. Zannad, W. G. Stough, B. Pitt, J. G.F. Cleland, K. F. Adams, N. L. Geller, C. Torp-Pedersen, B.-A. Kirwan, and F. Follath
Heart failure as an endpoint in heart failure and non-heart failure cardiovascular clinical trials: the need for a consensus definition
Eur. Heart J., February 1, 2008; 29(3): 413 - 421.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
I. Z. Ben-Dov and M. Bursztyn
Letter by Ben-Dov and Bursztyn Regarding Article, "Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial"
Circulation, January 16, 2007; 115(2): e18 - e18.
[Full Text] [PDF]

Home page
 CirculationHome page
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]

Home page
 Journal Watch CardiologyHome page
Which Antihypertensive Best Prevents HF in Patients with High BP?
Journal Watch Cardiology, June 1, 2006; 2006(601): 1 - 1.
[Full Text]

Home page
 BMJHome page
Minerva
BMJ, May 20, 2006; 332(7551): 1222 - 1222.
[Full Text] [PDF]

Home page
 CirculationHome page
S. Yusuf
Preventing Vascular Events Due to Elevated Blood Pressure
Circulation, May 9, 2006; 113(18): 2166 - 2168.
[Full Text] [PDF]


Circulation Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search
Copyright © 2006 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.