Blood pressure control by drug group in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)

Abstract

Blood pressure (BP) control rates and number of antihypertensive medications were compared (average follow-up, 4.9years) by randomized groups: chlorthalidone, 12.5-25mg/d (n=15,255), amlodipine 2.5-10mg/d (n=9048), or lisinopril 10-40mg/d (n=9054) in a randomized double-blind hypertension trial. Participants were hypertensives aged 55 or older with additional cardiovascular risk factor(s), recruited from 623 centers. Additional agents from other classes were added as needed to achieve BP control. BP was reduced from 145/83mm Hg (27% control) to 134/ 76mm Hg (chlorthalidone, 68% control), 135/75mm Hg (amlodipine, 66% control), and 136/76mm Hg (lisinopril, 61% control) by 5years; the mean number of drugs prescribed was 1.9, 2.0, and 2.1, respectively. Only 28% (chlorthalidone), 24% (amlodipine), and 24% (lisinopril) were controlled on monotherapy. BP control was achieved in the majority of each randomized group-a greater proportion with chlorthalidone. Over time, providers and patients should expect multidrug therapy to achieve BP <140/90mm Hg in a majority of patients. © 2008 Le Jacq.