Published online before print February 16, 2009, doi: 10.1161/HYPERTENSIONAHA.108.126169
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(Hypertension. 2009;53:595.)
© 2009 American Heart Association, Inc.
Editorial Commentaries |
Postgame Wrap of the Ultimate Blood Pressure Megatrial
Did It Score an ALLHAT Trick or Was It "Three Strikes and You’re Out?"
From the Robarts Research Institute and University of Western Ontario (R.D.F.), London, Ontario, Canada; and the Division of General Internal Medicine (F.A.M.), University of Alberta, Edmonton, Alberta, Canada.
Correspondence to Ross D. Feldman, Robarts Research Institute, 100 Perth Dr, PO Box 5015, London, Ontario, Canada N6A 5K8. E-mail feldmanr@lhsc.on.ca
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
I never heard a crowd boo a homer, but I’ve heard plenty of boos after a strikeout.— —Babe Ruth
It is a long base path that links the development and execution of a groundbreaking clinical trial with the assessment of its effect on clinical practice and ultimately health outcomes. The bases include the following: (1) publishing and disseminating the results of the study; (2) incorporating the findings into clinical practice recommendations (developed either informally or formally, as per the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Guidelines process); (3) impacting on clinical practice of healthcare professionals; and (4) impacting on patient outcomes and/or healthcare resource use.
In hypertension there has been a succession of landmark clinical trials that have dramatically affected the way we manage this disorder, eg, the initial Veterans Affairs trials, which proved that hypertension was not really "essential," and the Systolic Hypertension in the Elderly Program Study,1 which validated the benefits of treating systolic hypertension (remember the bad old days when it was taught that a normal blood pressure was "100 mm Hg plus their age"). These were truly "home runs" in the management of hypertension.
In this context, it is very appropriate to begin to examine the box score for the Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial (ALLHAT), certainly the largest and most robust primary prevention hypertension trial ever.2 This 3-way comparison among a diuretic, angiotensin-converting enzyme inhibitor, and calcium channel blocker finished as
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Hypertension 2009 53: 617-623.