(Hypertension. 2001;37:19.)
© 2001 American Heart Association, Inc.
Scientific Contributions |
Baseline Characteristics of Participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
From the Berman Center for Outcomes and Clinical Research and Hennepin County Medical Center (R.H.G., K.L.M.), Minneapolis, Minn; Veterans Affairs Medical Center (V.P.), Washington, DC; Memphis Veterans Affairs Medical Center (W.C.C.), Memphis, Tenn; University of Texas-Houston (C.E.F., J.B., C.M.H.), School of Public Health, Houston; Albert Einstein College of Medicine (M.H.A.), Bronx, NY; Veterans Affairs Medical Center (J.N.B.), Charleston, SC; Rush-Presbyterian-St. Luke’s Medical Center (H.R.B.), Chicago, Ill; Los Angeles County/University of Southern California Medical Center and White Memorial Medical Center (V.D.), Los Angeles; University of Minnesota Hospital and Clinic (J.E.), Minneapolis; Veterans Affairs Medical Center (H.M.P.), St. Louis, Mo; and the National Heart, Lung, and Blood Institute (M.P.), Division of Epidemiology and Clinical Applications, Bethesda, Md.
Correspondence to Richard H. Grimm, Jr, MD, PhD, Director, Berman Center for Outcomes and Clinical Research, Hennepin County Medical Center-865B, 701 Park Ave South, Minneapolis, MN 55415.
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Abstract |
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Abstract—Diuretics and ß-blockers have been shown to reduce the risk of cardiovascular morbidity and mortality in people with hypertension in long-term clinical trials. No study has compared newer more costly antihypertensive agents (calcium antagonists, ACE inhibitors, and
-adrenergic blockers) with
diuretics for reducing the incidence of
cardiovascular disease in an ethnically diverse group
of middle-aged and elderly hypertensive patients. The study is a
randomized, double-blind, active-controlled clinical trial designed to
determine whether the incidence of the primary outcome, fatal
coronary heart disease or nonfatal myocardial infarction,
differs between treatment initiation with a diuretic versus
each of 3 other antihypertensive drugs. Men and women aged 
55 years
with at least 1 other cardiovascular disease risk
factor were randomly assigned to chlorthalidone (12.5 to 25 mg/d),
amlodipine (2.5 to 10 mg/d), lisinopril (10 to 40 mg/d), or
doxazosin (2 to 8 mg/d) for planned follow-up of 4 to 8 years. This
report describes the baseline characteristics of the Antihypertensive
and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
participants. A total of 42 448 participants were randomized from 625
sites in the United States, Canada, Puerto Rico, and the US Virgin
Islands. The mean age was 67 years, with 35% aged 70 years. Among
those randomized, 36% were black, 19% were Hispanic, and 47% were
women. The sample includes a high proportion of people with diabetes
(36%), patients with existing cardiovascular disease
(47%), and smokers (22%). There were no important differences between
the randomized treatment groups at baseline. ALLHAT will add greatly to
our understanding of the management of hypertension by providing an
answer to the following question: are newer antihypertensive agents
similar, superior, or inferior to traditional treatment
with diuretics?
Key Words: hypertension, essential • antihypertensive agents • diuretics • clinical trials • lipids
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Introduction |
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Over 40 million people in the United States have elevated blood pressure (BP), ie, systolic BP (SBP)
140 mm Hg
and/or diastolic BP (DBP) 90 mm Hg, or they are
taking antihypertensive medication.1 Hypertension affects
half of white American men and women aged 60 to 74 years and over two
thirds of black men and women in this age group. Large-scale randomized
clinical trials conducted in the 1970s and 1980s in largely middle-aged
subjects with stage 1 and 2 hypertension (DBP 90 to 114 mm Hg)
demonstrated that antihypertensive drug treatment reduced the rate of
stroke by 40%. However, in contrast to the findings for stroke, the
reduction for coronary heart disease (CHD) events was 10% to
15%, which was less than expected on the basis of epidemiological
data.2 Subsequently, in the Systolic Hypertension in the Elderly Program (SHEP) trial, low-dose thiazide diuretic treatment was shown to reduce CHD death and nonfatal myocardial infarction (MI) by 27% (95% CI 6% to 43%).3 Other trials in older persons with diastolic and systolic hypertension reported similar results.4 5 One possible explanation for the failure of earlier trials to demonstrate the expected degree of CHD reduction is that adverse effects of study drugs, particularly high-dose thiazide diuretics, may have offset the potential benefit of BP reduction. These adverse effects include diuretic-induced hypokalemia, hypomagnesemia, hyperuricemia, hyperlipidemia, hyperglycemia, impaired insulin sensitivity, and, possibly, increased ventricular ectopic activity.5 6 7 8 However, these side effects are minimal at currently recommended doses (eg, 12.5 to 25 mg chlorthalidone), and a recent meta-analysis underlined the particular CHD benefit for regimens based on low-dose diuretics.9
In the late 1970s and the 1980s, newer and costlier antihypertensive
agents, such as calcium antagonists, ACE
inhibitors, and -adrenergic blockers, were introduced
for use as antihypertensive agents. However, evidence that might
justify their use in preference to the older classes of drugs is
limited and conflicting. Only a few studies have examined different
antihypertensive agents in parallel group trials. The ACE
inhibitor captopril has been compared with
diuretics and/or ß-blockers in 2 large trials, the Captopril
Prevention Project (CAPPP)10 and the UK Prospective
Diabetes Study (UKDPS).11 Neither study showed an overall
advantage for captopril in the prevention of the primary
cardiovascular end point. The results of some
observational studies and clinical trials have raised questions about
the efficacy of calcium antagonists, particularly the
short-acting dihydropyridines, for preventing
cardiovascular events in hypertensive patients with
heart disease or diabetes12 13 14 15 ; however, other data
suggest that the commonly prescribed calcium antagonists
are safe and effective for preventing cardiovascular
morbidity in these groups of patients.16 17 18 19
Four randomized trials have compared representatives of
3 drug classes. The 1-year trial conducted by the Department of
Veterans’ Affairs Cooperative Study Group on Antihypertensive
Agents,20 the 4-year HANE study,21 and
the 4.4-year Treatment of Mild Hypertension Study
(TOMHS)22 reported some differences in BP control, side
effects, quality of life, biochemical effects, and target-organ
changes. However, these differences did not present a pattern that
consistently favored one class of drugs over others. These
trials did not have cardiovascular end points as the
primary outcome for comparisons of drug classes. The recently completed
Swedish Trial in Old Patients with Hypertension (STOP-2)23
compared ACE inhibitors, calcium antagonists,
and diuretics and/or ß-blockers in 6614 older patients with
hypertension. In that study, BP reduction and fatal and nonfatal
cardiovascular events were similar among the 3 groups.
However, STOP-2 did not include blacks, persons with stage 1
hypertension, or anyone aged <70 years. Furthermore, the results of
this trial need confirmation in a larger trial with a broader
population of hypertensive persons.
Thus, more data are needed to permit an assessment of whether the newer classes of drugs are superior, equivalent, or inferior to diuretics for lowering the rates of hypertensive cardiovascular complications. In particular, the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study was designed to determine whether the combined incidence of fatal CHD and nonfatal MI differs between diuretic treatment and 3 alternative antihypertensive pharmacological treatments. To generalize the results of ALLHAT to a broad population of people with hypertension, the study was designed to recruit high proportions of groups heavily burdened by hypertension-related morbidity: the elderly, women, African Americans, and people with type 2 diabetes. In addition to the antihypertensive trial, the trial also randomized a subset of participants to a lipid-lowering trial designed to compare total mortality in patients with mild to moderate hypercholesterolemia randomized to pravastatin versus usual care. The baseline characteristics of this group will be described in a separate report. The present report describes in detail the baseline characteristics of the participants in the antihypertensive component of ALLHAT.
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Methods |
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The double-blind, randomized, active-controlled design of ALLHAT has been described in detail previously.24 The participants in ALLHAT are high-risk hypertensive patients recruited at 625 clinical sites in the United States, Canada, Puerto Rico, and the US Virgin Islands. Recruitment took place between February 14, 1994, and January 31, 1998. The trial is scheduled to end in March 2002, after a mean follow-up of 6 years. However, in February 2000, the doxazosin arm of the trial was discontinued because of the 4-year cumulative congestive heart failure rate of doxazosin compared with chlorthalidone (8.1% versus 4.5%, respectively). Additionally, there was a 25% higher risk of combined cardiovascular disease outcomes in the doxazosin group (relative risk 1.25, 95% CI 1.17 to 1.33).25
BP eligibility criteria were based on the patient’s current
antihypertensive treatment status and on the average of 2 seated BP
measurements at each of 2 visits. For untreated patients (or those
treated for <2 months), the BP inclusion criteria at both visits were
SBP of at least 140 mm Hg or DBP of at least 90 mm Hg. At
both visits, SBP 
180 mm Hg and DBP 110 mm Hg were
required. For those who had been on treatment with 1 to 2 drugs for 2
months, the criteria at visit 1 were SBP 160 mm Hg and DBP
100 mm Hg, and the criteria at visit 2 were SBP 180
mm Hg and DBP 110 mm Hg. The higher readings at visit 2
allowed for partial withdrawal of antihypertensive medication. Patients
who were taking therapeutic doses of >2 antihypertensive drugs were
not eligible. In addition to meeting the BP eligibility criteria,
patients had to be at least 55 years old and have at least 1 additional
risk factor for cardiovascular morbidity. These
additional inclusion criteria are listed in Table 1, along with the exclusion criteria for
the trial. The initial design included recruitment goals of 45% women
and 55% black participants.
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After giving their informed consent, participants were randomly assigned to receive 1 of 4 double-blinded step 1 treatments given once daily: chlorthalidone (12.5 mg for the first and second titration and 25 mg for the third), amlodipine (2.5, 5, or 10 mg), lisinopril (10, 20, or 40 mg), or doxazosin (2, 4, or 8 mg). Each of the study medications is identical in appearance at all dosages. Randomization was blocked and stratified by clinical center. Allocation of participants into each arm was in the ratio of 1.7:1:1:1, with the largest number assigned to chlorthalidone to maximize statistical power for the comparison of the diuretic arm to each of the 3 nondiuretic arms.
The initial doxazosin dose was 1 mg for 1 week, followed by 2 mg for 1 month and monthly titrations thereafter to achieve a BP goal of SBP <140 and DBP <90 mm Hg. Chlorthalidone, amlodipine, and lisinopril were titrated similarly, beginning with the lowest dose, except that there was no dosage change after 1 week. Additionally, open-label medications were provided to treat participants who did not attain satisfactory BP control on the maximum tolerated dose of blinded step 1 medication. Three open-label medications were available in step 2, and 1 was available in step 3. The step 2 medications provided include reserpine (0.05 to 0.2 mg daily), clonidine (0.1 to 0.3 mg twice daily), and atenolol (25 to 100 mg once daily). The step 3 medication is hydralazine (25 to 100 mg twice daily). All participants were given standard advice on lifestyle factors (sodium, alcohol, physical activity, and caloric intake), with reinforcement as needed during the study.
At baseline, participants had blood drawn for the measurement of serum potassium, fasting glucose, creatinine, total cholesterol, HDL cholesterol, triglycerides, and alanine aminotransferase. LDL cholesterol was estimated by the Friedewald formula. When possible, participants who had consumed food or beverages within the past 8 hours were asked to return later for a fasting blood draw. An ECG was performed if there was no existing ECG within the past year. All ECGs were then centrally read with the use of Minnesota Code criteria. At baseline, the clinical center study coordinator was instructed to complete a questionnaire listing the inclusion criteria (Table 1), checking all conditions that were known and documented to apply to the participant. In addition, the questionnaire included items about race, ethnicity, gender, years of education, current estrogen use, current regular aspirin use, cigarette smoking (past or current), and the presence of CHD. The presence of CHD was defined as a history of MI (including silent MI), primary cardiac arrest, coronary revascularization, angina, angiographically defined coronary stenosis >50%, or reversible coronary perfusion defect on noninvasive cardiac testing. Height and weight were measured at baseline.
For the baseline data in the present study, a participant was considered to have diabetes if type 2 diabetes mellitus was checked on the list of inclusion criteria (Table 1). The criteria for the diagnosis of diabetes were the criteria of the American Diabetes Association at the inception of the study, and these were not changed when the American Diabetes Association lowered the fasting glucose criterion in 1997.26 A participant was considered to have atherosclerotic cardiovascular disease (ASCVD) according to the following definition: if CHD as defined above was listed as present on the baseline questionnaire, or if the inclusion criteria checklist noted the presence of old or age-indeterminate MI or stroke, history of revascularization procedure, or other ASCVD (see Table 1 for definitions).
Follow-up procedures, study end points, and ascertainment of events have been described previously.24 25 The primary study end point is the combined incidence of fatal CHD and nonfatal MI. The study sample size was calculated to have 80% power to detect a 16% difference in the primary end point between the diuretic and each of the other 3 drug groups, after accounting for treatment crossovers, losses to follow-up, and multiple comparisons.
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Results |
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Table 2 provides the frequency distribution of ALLHAT randomized participants by race, ethnicity, gender, age at entry, history of diabetes, and preexisting ASCVD. Of the 42 448 participants randomized in ALLHAT, 25 292 (59.6%) were white, and 15 094 (35.6%) were black. Asians and American Indians made up 1.1% and 0.2%, respectively. Participants classifying themselves as "other" were the third largest group, with 1503 (or 3.5%) of the total randomized, most of whom also described themselves as being of Hispanic origin. There were 8100 (19.1%) Hispanic participants; of these, 65.6% designated themselves as "white Hispanic"; 17.4%, as "black Hispanic"; 0.2%, as either "Asian Hispanic" or "American Indian Hispanic"; and 16.8%, as "other Hispanic." Men constituted 53.2% of the ALLHAT participants. The largest age category for participants was aged 60 to 69 years (45.8%). The second largest age subgroup was aged 70 to 79 years (28.6%), and there were 19.1% aged 55 to 59 years and 6.5% aged
80 years. At
baseline, a large proportion of ALLHAT participants had diabetes
mellitus (36.0%) and/or evidence of ASCVD (46.9%).
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Table 3 shows baseline characteristics by randomized treatment group. By design, the chlorthalidone group was the largest, with 15 268 participants (36.0%), and each of the 3 other drug groups had just over 9000 participants (21.3%). In this table, and all subsequent tables, the non-Hispanic white category excludes the 5314 (12.5%) participants who described themselves as "white Hispanics." The participants have been combined with the "other" category. The black category includes both Hispanic and non-Hispanic blacks. The characteristics of Hispanic ALLHAT participants will be described in more detail in a separate publication. Three significant, but small, differences (P<0.05) in the randomized treatment groups were noted. There was a small difference in serum potassium between the lisinopril and chlorthalidone groups, which is likely due to the drawing of fasting blood after randomization in some participants. Compared with the chlorthalidone group, the participants randomized to amlodipine were slightly less likely to have a history of CHD and had a slightly lower creatinine level.
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Baseline characteristics by gender and race are provided in Table 4. The mean age of the participants was 67 years, and both male and female white participants were older than the black participants. This difference resulted primarily from a larger proportion of blacks compared with whites in the 55 to 59 age category (29.1% versus 15.8%, respectively) and a larger proportion of whites compared with blacks in the 70 to 79 age category (32.0% versus 25.9%, respectively). A smaller proportion of female participants compared with male participants was white (38.5% versus 54.6%, respectively), and a larger proportion was black (41.5% versus 30.4%, respectively).
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Most of the participants (90.2%) were receiving antihypertensive
treatment at baseline. Compared with other groups, blacks who had
received antihypertensive treatment for 2 months had slightly higher
baseline DBP and also had a lower BP control rate (SBP <140 and DBP
<90 mm Hg) at baseline compared with whites (26.9% versus
29.8%, respectively). The best BP control was observed in white males
(30.9%). BP control levels were 28.1% in white females, 27.6% in
black males, and 26.3% in black females. Black males were more likely
to be current smokers, and blacks, in general, were more likely to have
a history of diabetes, had a higher resting pulse, and had a higher
glucose level. Black women had higher body mass index, and blacks,
overall, compared with whites were much more likely to have central
laboratory readings of left ventricular
hypertrophy on ECG (8.6% versus 3.3%, respectively).
Whites were more likely than blacks to use aspirin (48% versus 25%,
respectively) and estrogen (28.4% versus 11.4%, respectively, among
women). Furthermore, whites were almost twice as likely as blacks to
have a history of CHD (33% versus 17%, respectively). Baseline
lipoprotein levels differed by race and gender subgroup. Blacks had
higher total cholesterol, LDL cholesterol, HDL
cholesterol, and markedly lower triglyceride
levels than did whites. Women had higher total cholesterol,
LDL cholesterol, and HDL cholesterol, whereas
men had higher triglycerides.
Table 5 lists the proportion of participants with each of the risk factor criteria that qualified participants for entry in the trial. Compared with black participants, white participants were more likely to be entered into the study on the basis of history of MI and/or stroke, revascularization procedures, or other ASCVD. Blacks more often qualified for the study for ischemic ECG changes, diabetes, smoking, and left ventricular hypertrophy on ECG. Men were more likely to be entered into the study because of previous MI, stroke, or revascularization, whereas women were more likely to be entered on the basis of a history of diabetes. Low HDL cholesterol, defined as <35 mg/dL, was a frequent inclusion criterion for white men (20.2%) but much less so in blacks and white women.
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Baseline characteristics for high-risk subgroups are given in Table 6. People with diabetes mellitus made up 15 294 (36.0%) of the ALLHAT participants. As expected, diabetic participants were more overweight compared with other groups, with a mean body mass index of 31.1 kg/m2. Diabetics also had higher fasting glucose (9.51 mmol/L), higher triglycerides (191.1 mg/dL), and lower HDL cholesterol (44.9 mg/dL) compared with other subgroups. There was a lower proportion of diabetes among participants with baseline cardiovascular disease and vice versa. In some cases, after eligibility was established, the documentation of additional entry criteria may have been incomplete. The group aged >70 years had somewhat higher baseline systolic and lower diastolic pressures compared with the other high-risk groups, and this group was more likely to have left ventricular hypertrophy. In both the >70-year-old and diabetic groups, women made up half of the group. Approximately 60% of the ASCVD and currently smoking subgroups were men.
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Discussion |
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ALLHAT is the largest randomized double-blind trial ever conducted in patients with hypertension. Over a period of 4 years, 625 centers in the United States, Canada, Puerto Rico, and the US Virgin Islands enrolled 42 448 high-risk patients. High risk was determined on the basis of the presence of hypertension, age
55 years, and at least 1
additional cardiovascular risk factor. Patients in ALLHAT were randomly assigned to 1 of 4 treatment groups: chlorthalidone, amlodipine, lisinopril, or doxazosin. The treatment groups were balanced at baseline, with no clinically important differences in any of the recorded variables. The study by design included a high percentage of African Americans (35.6%) and nearly equal proportions by gender (46.8% women). It also included a large cohort of Hispanic participants (19.1%). At entry, 35.1% of the patients were aged >70 years, 36% had diabetes, 46.9% had a history of ASCVD (over half of whom had CHD), and 22% were current smokers. Because of the large number of patients enrolled in ALLHAT, it will be possible to examine the effect of the ALLHAT treatments in these subgroups.
Blacks and Hispanics have been underrepresented in most previous trials. In hypertension trials that measured cardiovascular events, blacks have represented a significant subgroup only in trials with diuretic-based active therapy arms. Blacks are known to have more frequent and more severe hypertension that develops at an earlier age.1 This finding is reflected in the ALLHAT group at baseline: the black participants are younger and have higher DBP. Blacks also suffer more cardiovascular complications and have higher risk for end-stage renal disease.6 27 At baseline in the present study, compared with whites, blacks were less likely to be enrolled on the basis of a history of previous MI or stroke, revascularization procedures, or ASCVD, and blacks were more likely to be enrolled on the basis of diabetes, smoking, or left ventricular hypertrophy on ECG. ALLHAT will provide an excellent opportunity to study and evaluate the effect the type of therapy and BP control on cardiovascular events in blacks.
ALLHAT also may be able to address some questions raised from other trials. In CAPPP, patients with hypertension were randomized in an open-label fashion to either conventional therapy (diuretics or ß-blockers) or captopril.10 Although there was no difference in cardiovascular mortality or fatal and nonfatal MI between the 2 groups, fatal and nonfatal strokes were more frequent in the group treated with captopril. This finding was partially attributed to the fact that the captopril group had higher baseline SBP and baseline DBP, which remained slightly higher than values in the conventional therapy group throughout the study. No such baseline BP differences exist in ALLHAT.
The recently completed Heart Outcomes Prevention Evaluation (HOPE) study compared the effect of the ACE inhibitor ramipril with placebo in older high-risk patients with preserved left ventricular function.28 That study demonstrated that compared with placebo, ramipril significantly reduced the rates of death, MI, stroke, revascularization procedures, heart failure, and other cardiovascular complications. Less than half the patients in HOPE had hypertension. In hypertensive participants, study medication was added to their existing hypertensive therapy, resulting in lower SBP and DBP in ramipril-treated patients. Although this small amount of BP lowering (2 to 3 mm Hg) would be expected to account for well under half of the benefit of ramipril, the HOPE study design leaves many questions unanswered. Thus, ALLHAT still remains uniquely positioned to provide an answer to the primary question: are newer antihypertensive agents superior, similar, or inferior to traditional therapy with diuretics?
ALLHAT is an ongoing study examining the highest priority hypertension treatment question at the turn of the century. The results of ALLHAT will significantly add to our understanding of the management of hypertension and will also contribute to the formulation of future management guidelines.
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Acknowledgments |
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This study was supported by a contract with the National Heart, Lung, and Blood Institute.
Received May 2, 2000; first decision May 18, 2000; accepted June 30, 2000.
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 J. T. Wright Jr, J. L. Probstfield, W. C. Cushman, S. L. Pressel, J. A. Cutler, B. R. Davis, P. T. Einhorn, M. Rahman, P. K. Whelton, C. E. Ford, et al. ALLHAT Findings Revisited in the Context of Subsequent Analyses, Other Trials, and Meta-analyses Arch Intern Med, May 11, 2009; 169(9): 832 - 842. [Abstract] [Full Text] [PDF]
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 P. T. Einhorn National Heart, Lung, and Blood Institute-Initiated Program "Interventions to Improve Hypertension Control Rates in African Americans": Background and Implementation Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 236 - 240. [Full Text] [PDF]
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 B. L. Carter Antihypertensive Prescribing: Do We Have Reason to Celebrate? Hypertension, November 1, 2006; 48(5): 816 - 817. [Full Text] [PDF]
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F. H.H. Leenen, C. E. Nwachuku, H. R. Black, W. C. Cushman, B. R. Davis, L. M. Simpson, M. H. Alderman, S. A. Atlas, J. N. Basile, A. B. Cuyjet, et al. 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 Hypertension, September 1, 2006; 48(3): 374 - 384. [Abstract] [Full Text] [PDF]
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 A. L. Taylor, J. T. Wright Jr, R. S. Cooper, B. M. Psaty, A. L. Taylor, J. T. Wright Jr, R. S. Cooper, and B. M. Psaty Importance of Race/Ethnicity in Clinical Trials: Lessons From the African-American Heart Failure Trial (A-HeFT), the African-American Study of Kidney Disease and Hypertension (AASK), and the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Circulation, December 6, 2005; 112(23): 3654 - 3666. [Full Text] [PDF]
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D. K. Arnett, B. R. Davis, C. E. Ford, E. Boerwinkle, C. Leiendecker-Foster, M. B. Miller, H. Black, and J. H. Eckfeldt Pharmacogenetic Association of the Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism on Blood Pressure and Cardiovascular Risk in Relation to Antihypertensive Treatment: The Genetics of Hypertension-Associated Treatment (GenHAT) Study Circulation, June 28, 2005; 111(25): 3374 - 3383. [Abstract] [Full Text] [PDF]
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 J. T. Wright Jr, J. K. Dunn, J. A. Cutler, B. R. Davis, W. C. Cushman, C. E. Ford, L. J. Haywood, F. H. H. Leenen, K. L. Margolis, V. Papademetriou, et al. Outcomes in Hypertensive Black and Nonblack Patients Treated With Chlorthalidone, Amlodipine, and Lisinopril JAMA, April 6, 2005; 293(13): 1595 - 1608. [Abstract] [Full Text] [PDF]
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J. D. Neaton and L. H. Kuller Diuretics Are Color Blind JAMA, April 6, 2005; 293(13): 1663 - 1666. [Full Text] [PDF]
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 L. M. Brewster, G. A. van Montfrans, and J. Kleijnen Systematic Review: Antihypertensive Drug Therapy in Black Patients Ann Intern Med, October 19, 2004; 141(8): 614 - 627. [Abstract] [Full Text] [PDF]
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M. Rahman, C. D. Brown, J. Coresh, B. R. Davis, J. H. Eckfeldt, N. Kopyt, A. S. Levey, C. Nwachuku, S. Pressel, E. Reisin, et al. The Prevalence of Reduced Glomerular Filtration Rate in Older Hypertensive Patients and Its Association With Cardiovascular Disease: A Report From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Arch Intern Med, May 10, 2004; 164(9): 969 - 976. [Abstract] [Full Text] [PDF]
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S. R. Tunis, D. B. Stryer, and C. M. Clancy Practical Clinical Trials: Increasing the Value of Clinical Research for Decision Making in Clinical and Health Policy JAMA, September 24, 2003; 290(12): 1624 - 1632. [Abstract] [Full Text] [PDF]
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Diuretic Versus {alpha}-Blocker as First-Step Antihypertensive Therapy: Final Results From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Hypertension, September 1, 2003; 42(3): 239 - 246. [Abstract] [Full Text] [PDF]
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 T. E Strandberg, K. Pitkala, S. Berglind, M. S Nieminen, and R. S Tilvis Possibilities of multifactorial cardiovascular disease prevention in patients aged 75 and older: a randomized controlled trial: Drugs and Evidence Based Medicine in the Elderly (DEBATE) Study Eur. Heart J., July 1, 2003; 24(13): 1216 - 1222. [Abstract] [Full Text] [PDF]
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 M. H. Parker A Review of Cardiovascular Disease and Treatment Differences in Women Journal of Pharmacy Practice, June 1, 2003; 16(3): 157 - 163. [Abstract] [PDF]
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S. Oparil Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): Practical Implications Hypertension, May 1, 2003; 41(5): 1006 - 1009. [Full Text] [PDF]
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The ALLHAT Officers and Coordinators for the ALLHA 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, December 18, 2002; 288(23): 2981 - 2997. [Abstract] [Full Text] [PDF]
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J.-J. Mourad, J. Blacher, P. Blin, and U. Warzocha Conventional Antihypertensive Drug Therapy Does Not Prevent the Increase of Pulse Pressure With Age Hypertension, October 1, 2001; 38(4): 958 - 961. [Abstract] [Full Text] [PDF]
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M. Epstein and H. R. Black Arterial Calcification and Calcium Antagonists : What Does It Mean? Hypertension, June 1, 2001; 37(6): 1414 - 1415. [Full Text] [PDF]
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