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(Hypertension. 2006;48:359.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Amlodipine Better Than Lisinopril?

How One Randomized Clinical Trial Ended Fallacies From Observational Studies

Franz H. Messerli; Jan A. Staessen

From the Hypertension Program (F.H.M.), Division of Cardiology, St Luke’s-Roosevelt Hospital, New York, NY; and the Studies Coordinating Centre (J.A.S.), Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Disease, University of Leuven, Leuven, Belgium.

Correspondence to Franz H. Messerli, Division of Cardiology, St Luke’s-Roosevelt Hospital, 1000 Tenth Ave, Suite 3b-30, New York, NY 10019. E-mail fmesserli@aol.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) compared in >30 000 high-risk hypertensive patients the effects on coronary heart disease of 3 treatment strategies: (1) based on the diuretic chlorthalidone, (2) the calcium-channel blocker (CCB) amlodipine, and (3) the angiotensin converting-enzyme (ACE) inhibitor lisinopril, respectively.¹ Sponsored by the National Heart, Lung, and Blood Institute, ALLHAT stands out because no differences occurred in the incidence of the primary end point that consisted of the combination of fatal coronary heart disease and acute myocardial infarction.¹ Not surprisingly, the attention of the ALLHAT consortium shifted to secondary end points, such as stroke, or to loosely defined² components of secondary end points, such as heart failure. At the end of the line, the ALLHAT investigators based their main conclusions on events that, at the initiation of the trial, they regarded as "soft data that will at best confirm or supplement the primary endpoint."³ More importantly, what was not identical in the 3 treatment groups was the on-treatment blood pressure despite vigorous attempts to titrate and combine the study medications to achieve a blood pressure of <140 mm Hg systolic and 90 mm Hg diastolic.¹ These salient features of ALLHAT should be kept in mind whenever one attempts to interpret the findings of this landmark trial.

In this issue of Hypertension, Leenen et al⁴ published a post hoc analysis, in which they made a direct comparison of cardiovascular and other outcomes among the 18 102 ALLHAT participants randomly assigned to . . . [Full Text of this Article]

Related Article:

Clinical Events in High-Risk Hypertensive Patients Randomly Assigned to Calcium Channel Blocker Versus Angiotensin-Converting Enzyme Inhibitor in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Frans H.H. Leenen, Chuke E. Nwachuku, Henry R. Black, William C. Cushman, Barry R. Davis, Lara M. Simpson, Michael H. Alderman, Steven A. Atlas, Jan N. Basile, Aloysius B. Cuyjet, Richard Dart, James V. Felicetta, Richard H. Grimm, L. Julian Haywood, Syed Z.A. Jafri, Michael A. Proschan, Udho Thadani, Paul K. Whelton, Jackson T. Wright for the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Collaborative Research Group
Hypertension 2006 48: 374-384. [Abstract] [Full Text] [PDF]

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