Lipid- lowering/antihypertensive

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. 

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. 

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). 

Chitturi S, George J (2002) Hepatotoxicity of commonly used drugs nonsteroidal anti-inflammatory drugs, antihypertensives, antidiabetic agents, anticonvulsants, lipid-lowering agents, psychotropic drugs. Semin Liver Dis 22 169-183. 

VASODILATOR ANTIHYPERTENSIVES LIPID-LOWERING DRUGS Bosentan lowers simvastatin levels Uncertain bosentan moderately inhibits CYP3A4 Monitor lipid profile closely look for poor response to simvastatin... 

Current predictions suggest that the twin epidemics of obesity and diabetes worldwide will result in an increase in CVD rates, which have sharply declined over the past 30 years, after the introduction of effective lipid-lowering and antihypertensive therapies. The World Health Organization (WHO) reported that in 2002, deaths from CVD outnumbered deaths from the major communicable diseases (AIDS, tuberculosis, and malaria) by 3 to 1 (2). By 2015, an estimated 20 million people will die annually from CVD. Therefore, with the advent of the new millennium, there is a sense of urgency to address the burden of chronic cardiometabolic diseases worldwide. The information on the prevalence and etiology of cardiometabolic diseases, which is cited in this section was obtained from the WHO and Centers for Disease Control (CDC) websites (2-6). 

Numerous drugs are marketed to treat metabolic diseases, which include weight reducing agents, antidiabetics, lipid-lowering treatments, and antihypertensives. The pharmacology, positive attributes, efficacy, and limitations for each drug class are summarized in Tables (2-5) (56, 57). 

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. 

Messerli FH. Implications of discontinuation of doxazosin arm of AT T HAT Antihypertensive and Lipid-Lowering Treatment to lYevent Heart Attack Trial Lancet 2000355(9207) 863-4. 

Davis BR, Cutler JA, Furberg CD, et al. Relationship of antihypertensive treatment regimens and change in blood pressure to risk for heart failure in hypertensive patients randomly assigned to doxazosin or chlorthalidone further analyses from the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial. Ann Intern Med 2002 137 313-320. 

The results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was the deciding evidence that the JNC7 used to justify thiazide diuretics as first-line therapy." It was designed to test the hypothesis that newer antihypertensive agents (an a-blocker, ACE inhibitor, and dihydropyridine CCB) would be superior to thiazide diuretic therapy. The primary objective was to compare the combined end point of fatal coronary heart disease and nonfatal myocardial infarction. Other hypertension-related complications (e.g., heart failure and stroke) were evaluated as secondary end points. This was the largest hypertension trial ever conducted and included 42,418 patients aged 55 years and older with hypertension and one additional cardiovascular risk factor. This prospective, double-blind trial randomized patients to chlorthalidone (a thiazide diuretic), amlodipine (dihydropyridine CCB), doxazosin (a-blocker), or lisinopril (ACE inhibitor) for a mean follow-up of 4.9 years. 

Diuretic versus alpha-blocker as first-step antihypertensive therapy Final results from the Antihypertensive and Lipid-Lowering Treatment... 

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