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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Ford, PhD, Linda B. Bone mineral density changes among women initiating blood pressure lowering drugs: For amlodipine vs chlorthalidone, secondary outcomes were similar except for a higher 6-year rate of HF with amlodipine Purchase access Subscribe now. Purchase access Subscribe to the journal. Hypertension is a risk factor for fractures. Seventy pelvic and hip fractures setudio in the cohort with in-trial and posttrial follow-up. Zllhat Elam, MS, The Estudlo of Texas School of Public Health, provided early editorial assistance in the preparation of the manuscript and was compensated for her work as an employee of the Coordinating Center.

Conflict of Interest Disclosures: Given that atenolol was used as an add-on medication in ALLHAT, this finding should be viewed with a great deal of caution. Risk of fractures in older adults using antihypertensive medications. Wright JT, et al. Cochrane Database Syst Rev. Less is known regarding the effects of angiotensin-converting enzyme inhibitors ACEis and calcium channel blockers CCBs on alhat risk despite their ubiquitous use in older adults with hypertension. Prescribing patterns for thiazide diuretics in a large health maintenance organization: Such ascertainment results in less underestimation of hip fracture incidence than methods based on self-report.


These risk factors included previous myocardial infarction or stroke, left ventricular hypertrophy by electrocardiography or echocardiography, history of type 2 diabetes, current cigarette smoking, and low high-density lipoprotein cholesterol level. Participants were randomly assigned to receive chlorthalidone, Zuliani; Prince Edwards Island: J Clin Hypertens Greenwich.

Design and Conclusions of the ALLHAT Study

Potential effect of angiotensin II receptor blockade in adipose tissue and bone. Correct interpretation of a trial should be based on the question that it was designed to answer.

Cardiovascular Medications and Fractures. In the cohort with in-trial and posttrial follow-up, 69 pelvic and hip fractures occurred during the in-trial and posttrial periods. Doxazosin arm terminated early and not included in analysis.

Design and Conclusions of the ALLHAT Study | Revista Española de Cardiología (English Edition)

In patients with hypertension, chlorthalidone, amlodipine, and lisinopril performed similarly in regards to fatal CAD and nonfatal MI. 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.

The potential effect of atenolol use on fracture risk in participants taking chlorthalidone during the in-trial period is presented in eTable 3 and eFigure 2 in the Supplement.

During the entire trial and posttrial period of follow-up, the cumulative incidence of fractures was nonsignificantly lower in participants randomized estudii receive chlorthalidone vs lisinopril or amlodipine HR, 0. PubMed Google Scholar Crossref. We hypothesized fewer in-trial fracture hospitalizations in zllhat randomized to chlorthalidone vs comparators and that this benefit would persist into the posttrial surveillance period when participants were no longer randomized to study medications.

Chlorthalidone use was associated with a significantly lower risk of fracture compared with lisinopril use HR, 0. The study drug was instituted and additional open-label agents were added to achieve BP goals.


Given these results and the widespread use of ACEis for the treatment of hypertension in older adults, our finding has potentially important public health implications.

Posttrial follow-up was conducted through the end ofusing aallhat surveillance via national databases. Outcomes analysis used an intention-to-treat approach. Although randomization is not strictly maintained with this approach, this was done for 2 reasons: No specific funding was allocated for the work presented in this article.

ALLHAT – Wiki Journal Club

Second, analyses that included in-trial and posttrial follow-up yielded a fracture risk that was no longer significantly different between the treatment groups, albeit it was still numerically lowest in the chlorthalidone group. The primary outcome occurred in participants, with no difference between treatments.

Dr Cushman reports receiving honoraria from Takeda. Risk of falls associated with antihypertensive medication: During the in-trial period mean [SD] allha, 3.

Estimating equations for glomerular filtration rate in the era of creatinine standardization: Although this approach is highly accurate for diagnosing fractures, 23 participants eligible for Medicare who were enrolled in managed care would not have hospitalizations recorded with Medicare, thereby lowering the number of participants with fractures.

No statistically significant differences were observed. Heterogeneity was assessed for age, race, sex, diabetes, eGFR, incident and prevalent CVD, body mass index, smoking, and for females hormone replacement therapy.