Published in , the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) sought to determine which of. Request PDF on ResearchGate | On Jul 1, , José Ramón González- Juanatey and others published Después del estudio ALLHAT, ¿qué sabemos de lo que. Después del estudio ALLHAT, ¿qué sabemos de lo que desconocíamos sobre el and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
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Design and Conclusions of the ALLHAT Study | Revista Española de Cardiología (English Edition)
Hazards ratios HRs were adjusted for age, race, sex, aplhat, baseline estimated estjdio filtration rate eGFRprevalent cardiovascular disease CVDbody mass index, and smoking. For the initial curves A and Bin the in-trial cohort, the unadjusted hazard ratio HR was 0. Similar trends were found when chlorthalidone use was compared with lisinopril or amlodipine use separately eFigure 1 in the Supplement. For sensitivity analyses, the incidence of fractures was calculated beginning 1 year after study enrollment.
But the study does not demonstrate the advantages of some combinations over others because we do not know what combination the patients received and, moreover, the combined drugs were administered in an open-label manner. No statistically significant differences were observed. Thirty-four participants had pelvic fractures etudio participants had hip fractures during the in-trial period mean [SD] follow-up, 4. Data are summarized as means Aolhat for continuous variables and numbers percentages of study participants for categorical variables.
Secondary outcomes were all-cause mortality, stroke, combined CHD primary outcome, coronary revascularization, or angina with hospitalizationand combined CVD combined CHD, stroke, treated angina without hospitalization, heart failure [HF], and peripheral arterial disease.
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Risk of falls associated with antihypertensive medication: Navigation menu Personal tools Create account Log in. This finding was consistent in all subgroup comparisons. One year after the thiazide use was stopped, there was no difference in BMD compared with the placebo group, suggesting rapid loss of the beneficial effect of the diuretic.
Dr Cushman reports receiving honoraria from Takeda. Antihypertensive medications, bone mineral density, and fractures: Chlorthalidone use was associated with a significantly lower risk of fracture compared with lisinopril use HR, 0. Participants randomized to receive chlorthalidone vs amlodipine or lisinopril had a lower risk of fracture estudioo adjusted analyses hazards ratio [HR], 0.
This page was last modified on 14 Estudjoat Zuliani; Prince Edwards Island: Critical revision of the manuscript for important intellectual content: Drs Davis and Barzilay had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Third, we relied on databases rather than medical records to ascertain fracture occurrence. Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, The lower cost of diuretics may justify their use provided there are no contraindications or express indications for another drug, but the superiority of diuretics has not been proved by the ALLHAT study.
Design and Conclusions of the ALLHAT Study
Images subject to Copyright. Adjustment for demographic and clinical variables marginally changed this estimate HR, 1. It would have become available in the market 6 months later at the earliest.
For the primary analyses, we combined those separately assigned to amlodipine and lisinopril into 1 group for greater statistical power. Moreover, the use of bisphosphonates became common only in the early s, after the release of several large fracture trials.
Fully adjusted hip and pelvic fracture HRs, stratified by selected variables, are shown for the in-trial cohort in Figure 3 and eFigure 3 in the Supplement. Interaction terms were not statistically significant with P values ranging from. We asked 3 questions: Administrative, technical, or material support: The in-trial cohort consisted of participants randomized to chlorthalidone, amlodipine, or lisinopril, with or without atenolol at month 1 of follow-up from baseline Figure 1 A.
Thiazide for the postponement of postmenopausal bone loss. The interpretation of the differences for the secondary objectives does not consider the complexity of treatment, and the comparison is based on the initial randomization group, which does not ensure that the patient received the corresponding drug. The optimal choice of antihypertensive for prevention of CAD endpoints was unclear.
The groups were equally balanced in all aspects except that in-trial participants randomized to receive chlorthalidone had more baseline CHD than the amlodipine and lisinopril groups Hypertension is a risk factor for fractures.
Participants younger than 65 years at randomization enrolled by non-VA clinics and participants from Canada were not included because they would not have had continuous coverage in either data source.
Potential effect of angiotensin II receptor blockade in adipose tissue and bone. Medications supplied by Pfizer amlodipine, doxazosinAstraZeneca atenolol, lisinopril and Bristol-Myers Squibb pravastatin. To determine whether treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease CHD or other cardiovascular disease CVD events vs treatment with a diuretic.
This effect is consistently observed in a variety of subgroups and appears to last for several years.