The ALLHAT Report: A Case of Information and Misinformation
Why the study?
Does chlorthalidone reduce fatal coronary heart disease and nonfatal myocardial infarction compared to lisinopril and amlodipine in hypertensive patients?
Population
Hypertensive patients (based on discussion of the ALLHAT trial)
Comparison
Chlorthalidone vs Lisinopril and amlodipine
Design
Editorial
Authors
Discussion
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Member takes
Implication
This editorial argues that the ALLHAT trial's claims of chlorthalidone's superiority are flawed due to unequal blood pressure control across arms and potential misdiagnosis of heart failure.
Structured PICO
Does chlorthalidone reduce fatal coronary heart disease and nonfatal myocardial infarction compared to lisinopril and amlodipine in hypertensive patients?
P
Population
Hypertensive patients (based on discussion of the ALLHAT trial)
I
Intervention
Chlorthalidone
C
Comparator
Lisinopril and amlodipine
O
Outcome
Fatal coronary heart disease and nonfatal myocardial infarctioncomposite
This editorial argues that the ALLHAT trial's claims of chlorthalidone's superiority are flawed due to unequal blood pressure control across arms and potential misdiagnosis of heart failure.
Limitations
- Unequal blood pressure control between groups (2-4 mm Hg difference favoring chlorthalidone)
- Protocol restrictions on add-on therapies disadvantaged lisinopril
- Masking effect of diuretics on heart failure symptoms
- Lack of rigorous confirmation of clinical events for heart failure
Cite This Study
Michael A. Weber (2003) studied this question.