ALLHAT

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). JAMA 2002 288(23) =2981-2997. 

In patients with BPH and hypertension, it is not recommended to use an a-adrenergic antagonist alone to treat both disorders. In the ALLHAT study, where doxazosin was compared to other agents for treatment of essential hypertension, doxazosin was associated with a higher incidence of congestive heart failure. Therefore, in patients with hypertension and BPH, it is recommended that an appropriate antihypertensive be added to an a-adrenergic antagonist.11... 

Geriatric Considerations - Summary Alpha-adrenergic blockers are modestly effective alone, and in combination with 5-alpha reductase inhibitors (e g, finasteride) in the treatment of urinary obstructive symptoms related to benign prostatic hyperplasia, The main side effect of these agents is orthostatic hypotension, and in hypertensive patients, these agents may increase the risk of congestive heart failure as reported in the ALLHAT study. 

Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. )AMA 2000 283 1967-1975. 

The doxazosin arm of the ALLHAT study was stopped early the doxazosin group had a 25%greater risk of combined cardiovascular disease events which was primarily accounted for by a doubled risk of CHF vs the chlorthalidone group doxazosin was also found to be less effective at controlling systolic BP an average of 3 mm Hg may want to consider primary antihypertensives in addition to a-blockers for BPH symptoms... 

A recent very large study (over 30,000 participants) has shown that inexpensive diuretics are similar or superior in outcomes to ACE inhibitor or calcium channel blocker therapy (ALLHAT, 2002). 

In high-risk individuals and groups people with clinical evidence of macrovascular disease other than CHD, the Heart Protection Study (HPS) (II) with diabetes, the HPS and Collaborative Atorvastatin Diabetes Study (CARDS) (12) the elderly, Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) (13) or with hypertension, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (14) and Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) (15). 

The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2000). JAMA 283, 1967-1975. 

In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), over 40 000 participants aged 55 years or older with hypertension and at least one other risk factor for coronary heart disease were randomized to chlortalidone, amlodipine, doxazosin, or lisinopril (1,2). Doxazosin was discontinued prematurely because chlortalidone was clearly superior in preventing cardiovascular events, particularly heart failure (2). Otherwise, mean follow-up was 4.9 years. There were no differences between chlortalidone, amlodipine, and lisinopril in the primary combined outcome or allcause mortality. Compared with chlortalidone, heart failure was more common with amlodipine and lisinopril, and chlortalidone was better than lisinopril at preventing stroke. 

Beevers DG, Lip GY. Do alpha blockers cause heart failure and stroke Observations from ALLHAT. J Hum Hypertens 2000 14(5) 287-9. 

Elevated SBP has been shown to be associated with an increased risk of stroke, CHF, myocardial infarction and death [140,141]. The authors of the ALLHAT study suggested that a 3 mm Hg increase in SBP could explain a 10 % to 20% increase in the incidence of CHF [142]. In a meta-analysis of 15, 693 older patients with isolated systolic hypertension from 8 trials, a 10 mmHg higher initial SBP was associated with relative hazard rates of 1.26 (p=0.001) for total mortality, 1.22 (p=0.007) for cardiovascular mortality, and 1.22 (p=0.02) for stroke [143]. The recent meta-analysis by Aw et al [66A] involving 45451 patients found that rofecoxib was associated with a higher risk of developing hypertension compared to celecoxib. 

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