Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial

Context: Antihypertensive therapy is well established to reduce hypertension related morbidity and mortality, but the optimal first step therapy is unknown. OBJECTIVE: To determine whether treatment with a calcium channel blocker or an angiotensin converting enzyme inhibitor lowers the incidence of...

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Autores principales:	Rada G,Gabriel, Montero L,Joaquín
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2004
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000400017
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spelling	oai:scielo:S0034-988720040004000172004-12-13Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterialRada G,GabrielMontero L,JoaquínContext: Antihypertensive therapy is well established to reduce hypertension related morbidity and mortality, but the optimal first step therapy is unknown. OBJECTIVE: To determine whether treatment with a calcium channel blocker or an angiotensin converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. DESIGN: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double blind, active controlled clinical trial conducted from February 1994 through March 2002. Setting and participants: A total of 33357 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from 623 North American centers. INTERVENTIONS: Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n = 15255); amlodipine, 2.5 to 10 mg/d (n = 9048); or lisinopril, 10 to 40 mg/d (n = 9054) for planned follow up of approximately 4 to 8 years. Main outcome measures: The primary outcome was combined fatal CHD or nonfatal myocardial infarction, analyzed by intent to treat. Secondary outcomes were all cause mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure [HF], and peripheral arterial disease). Results: Mean follow up was 4.9 years. The primary outcome occurred in 2956 participants, with no difference between treatments. Compared with chlorthalidone (6 years rate, 11.5%), the relative risks (RRs) were 0.98 (95% CI, 0.90-1.07) for amlodipine (6 years rate, 11.3%) and 0.99 (95% CI, 0.91-1.08) for lisinopril (6 years rate, 11.4%). Likewise, all cause mortality did not differ between groups. Five years systolic blood pressures were significantly higher in the amlodipine (0.8 mm Hg, P =.03) and lisinopril (2 mm Hg, P <.001) groups compared with chlorthalidone, and 5 years diastolic blood pressure was significantly lower with amlodipine (0.8 mm Hg, P <.001). For amlodipine vs chlorthalidone, secondary outcomes were similar except for a higher 6 years rate of HF with amlodipine (10.2% vs 7.7%; RR, 1.38; 95% CI, 1.25-1.52). For lisinopril vs chlorthalidone, lisinopril had higher 6 years rates of combined CVD (33.3% vs 30.9%; RR, 1.10; 95% CI, 1.05-1.16); stroke (6.3% vs 5.6%; RR, 1.15; 95% CI, 1.02-1.30); and HF (8.7% vs 7.7%; RR, 1.19; 95% CI, 1.07-1.31). Conclusion: Thiazide type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive. They should be preferred for first step antihypertensive therapyinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.132 n.4 20042004-04-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000400017es10.4067/S0034-98872004000400017
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
description	Context: Antihypertensive therapy is well established to reduce hypertension related morbidity and mortality, but the optimal first step therapy is unknown. OBJECTIVE: To determine whether treatment with a calcium channel blocker or an angiotensin converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. DESIGN: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double blind, active controlled clinical trial conducted from February 1994 through March 2002. Setting and participants: A total of 33357 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from 623 North American centers. INTERVENTIONS: Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n = 15255); amlodipine, 2.5 to 10 mg/d (n = 9048); or lisinopril, 10 to 40 mg/d (n = 9054) for planned follow up of approximately 4 to 8 years. Main outcome measures: The primary outcome was combined fatal CHD or nonfatal myocardial infarction, analyzed by intent to treat. Secondary outcomes were all cause mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure [HF], and peripheral arterial disease). Results: Mean follow up was 4.9 years. The primary outcome occurred in 2956 participants, with no difference between treatments. Compared with chlorthalidone (6 years rate, 11.5%), the relative risks (RRs) were 0.98 (95% CI, 0.90-1.07) for amlodipine (6 years rate, 11.3%) and 0.99 (95% CI, 0.91-1.08) for lisinopril (6 years rate, 11.4%). Likewise, all cause mortality did not differ between groups. Five years systolic blood pressures were significantly higher in the amlodipine (0.8 mm Hg, P =.03) and lisinopril (2 mm Hg, P <.001) groups compared with chlorthalidone, and 5 years diastolic blood pressure was significantly lower with amlodipine (0.8 mm Hg, P <.001). For amlodipine vs chlorthalidone, secondary outcomes were similar except for a higher 6 years rate of HF with amlodipine (10.2% vs 7.7%; RR, 1.38; 95% CI, 1.25-1.52). For lisinopril vs chlorthalidone, lisinopril had higher 6 years rates of combined CVD (33.3% vs 30.9%; RR, 1.10; 95% CI, 1.05-1.16); stroke (6.3% vs 5.6%; RR, 1.15; 95% CI, 1.02-1.30); and HF (8.7% vs 7.7%; RR, 1.19; 95% CI, 1.07-1.31). Conclusion: Thiazide type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive. They should be preferred for first step antihypertensive therapy
author	Rada G,Gabriel Montero L,Joaquín
spellingShingle	Rada G,Gabriel Montero L,Joaquín Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial
author_facet	Rada G,Gabriel Montero L,Joaquín
author_sort	Rada G,Gabriel
title	Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial
title_short	Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial
title_full	Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial
title_fullStr	Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial
title_full_unstemmed	Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial
title_sort	análisis crítico de un artículo:el estudio allhat: diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial
publisher	Sociedad Médica de Santiago
publishDate	2004
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000400017
work_keys_str_mv	AT radaggabriel analisiscriticodeunarticuloelestudioallhatdiureticostipotiazidasserianelfarmacodeeleccionparainiciartratamientoenhipertensionarterial AT monteroljoaquin analisiscriticodeunarticuloelestudioallhatdiureticostipotiazidasserianelfarmacodeeleccionparainiciartratamientoenhipertensionarterial
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Análisis crítico de un artículo:El estudio ALLHAT: Diuréticos tipo tiazidas serían el fármaco de elección para iniciar tratamiento en hipertensión arterial

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