2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Salvetti, A. Articles by Ghiadoni, L. Search for Related Content PubMed PubMed Citation Articles by Salvetti, A. Articles by Ghiadoni, L.

Guidelines for Antihypertensive Treatment: An Update after the ALLHAT Study

Department of Internal Medicine, University of Pisa, Pisa, Italy

Correspondence to Prof. Antonio Salvetti, Department of Internal Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy. Phone and Fax: +39-0553407; E-mail: a.salvetti{at}med.unipi.it

ABSTRACT. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Study, the largest double-blind, randomized trial in hypertensive patients, confirmed and strengthened the clinical relevance of thiazide diuretics in the treatment of hypertension but did not prove the superiority of these drugs. Its claim of the superiority of chlorthalidone was based on some secondary outcomes, principally represented by (1) an increased incidence of stroke in the doxazosin and lisinopril arms, an effect that might be explained by differences in systolic BP; (2) greater morbidity but not mortality for congestive heart failure (CHF) in the doxazosin, amlodipine, and lisinopril arms, a finding that might reflect poor accuracy in the diagnosis and/or especially the switching from diuretic treatment in 90% of patients. Moreover, the ALLHAT study has other limitations, and its conclusions are in contrast with data from overall controlled clinical trials indicating that given the same BP reduction, the benefit of different drug classes is similar. As to whether the ALLHAT study will influence ongoing guidelines concerning the choice of antihypertensive drugs, the answer is "yes" if interpretation of its data in favor of diuretics and cost of drugs become the preponderant considerations, as it was in recent JNC VII guidelines. However, the more liberal approach based on the choice of all available drug classes seems still to be valid, as is in the ESH-ESC guidelines, if the preponderant consideration is that the real benefit of antihypertensive therapy is due to efficient BP control and not to a particular benefit of a single drug class.

This article has been cited by other articles:

				A. Spirou, E. Rizos, E. N. Liberopoulos, N. Kolaitis, A. Achimastos, A. D. Tselepis, and M. Elisaf Effect of Barnidipine on Blood Pressure and Serum Metabolic Parameters in Patients With Essential Hypertension: A Pilot Study Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2006; 11(4): 256 - 261. [Abstract] [PDF]

				Q. Fu, R. Zhang, S. Witkowski, A. Arbab-Zadeh, A. Prasad, K. Okazaki, and B. D. Levine Persistent Sympathetic Activation During Chronic Antihypertensive Therapy: A Potential Mechanism for Long Term Morbidity? Hypertension, April 1, 2005; 45(4): 513 - 521. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673