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Thiazides still first, say ALLHAT authors
Reviewing data from other recent hypertensive studies, meta-analyses and sub-group analyses of their study, the ALLHAT authors say that when used in hypertension the thiazide diuretic chlorthalidone was more effective than lisinopril in preventing cardiovascular events and heart failure, and superior to amlodipine in preventing heart failure.
Seven years from the controversial ALLHAT hypertension trial, thiazides are still the best first line treatment for hypertension, say the study authors.
A re-evaluation of the major 2002 trial and other subsequent studies in hypertension have reaffirmed their main finding that a thiazide diuretic is superior to ACE inhibitor or calcium, channel blocker for initial control of hypertension, they say.
Writing in the Archives of Internal Medicine (169(9):832-842) this week, they say that despite thiazides having some adverse effects on surrogate markers of health such as blood glucose and cholesterol, the benefits of the drug on cardiovascular outcomes remain superior to other antihypertensives.
Reviewing data from other recent hypertensive studies, meta-analyses and sub-group analyses of their study, the ALLHAT authors say that when used in hypertension the thiazide diuretic chlorthalidone was more effective than lisinopril in preventing cardiovascular events and heart failure, and superior to amlodipine in preventing heart failure.
In addition, the ACE inhibitor and calcium channel blocker did not surpass the thiazide on renal outcomes, they add.
“More complete and subsequent trial and meta-analytic data are consistent in confirming initial ALLHAT findings that (despite having more favourable effects on glucose and lipid levels and other surrogate variables) neither the ... ACE inhibitor nor the calcium channel blocker surpasses the thiazide-type diuretic as initial therapy for control of BP or reduction of cardiovascular or renal clinical outcomes, they conclude.
However, they concede that the thiazide benefits in stroke were only seen in black patients.