The Archives of Internal Medicine has published an article that reviews the results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) in the context of meta-analyses, other trials and more recent analyses of the ALLHAT data.
This review considers the results of ALLHAT in conjunction with several other large hypertension trials including ASCOT, ACCOMPLISH, INSIGHT and CONVINCE. Differences in study design, treatment and outcome blinding and blood pressure lowering effect in different treatment arms are discussed.
The authors conclude that, "neither the alpha-blocker, ACE inhibitor, nor the CCB surpasses the thiazide-type diuretic as initial therapy for control of BP or reduction of cardiovascular or renal clinical outcomes". This is despite concerns that thiazide-type diuretics have unfavourable effects on glucose and lipid levels.
Action: The current NICE hypertension guideline presents clinicians with a choice of a diuretic or calcium channel blocker for black patients or those aged 55 year and older. This review would support first-line therapy with thiazide-type diuretics.
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