Allhat trial and doxazosin

ALLHAT was the largest trial of treatments for high blood pressure and the second-largest trial of treatments for high cholesterol. The ALLHAT blood pressure trial compared the effects of three blood pressure-lowering drugs—a calcium channel blocker amlodipine , an angiotensin converting enzyme ACE inhibitor lisinopril , and an alpha-adrenergic blocker doxazosin —with the effects of a diuretic chlorthalidone , which was the control treatment in the trial.

During the s and early s, the use of diuretics to treat high blood pressure had declined as use of the other drugs had increased. The ALLHAT cholesterol trial enrolled participants in the blood pressure trial who had moderately elevated cholesterol. The blood pressure and cholesterol trials were conducted concurrently. The cholesterol trial compared two groups of participants. One group received a cholesterol-lowering statin drug pravastatin in addition to the usual care for moderately elevated cholesterol.

The other group received only the usual care. When the study began, the usual care included advice about dietary modification and no cholesterol-lowering drug. However, over the eight years the trial was conducted, the usual care evolved to include statins, some of which were more potent than pravastatin.

The ALLHAT blood pressure trial found that the calcium channel blocker, ACE inhibitor, and alpha-adrenergic blocker did not work better than the diuretic to control high blood pressure and prevent stroke and some forms of heart disease, including heart attack and heart failure.

Compared to the diuretic, the alpha-adrenergic blocker was less effective at controlling high blood pressure and was associated with much higher heart failure rates. Researchers stopped the study of this drug a year early. Other studies have also informed clinical care for high blood pressure.

For example, ALLHAT did not study beta blockers, but previous trials have found that beta blockers lower blood pressure and prevent heart problems and strokes. For the statin group, the trial provided a cholesterol-lowering statin drug and advice about dietary modification. For the usual care group, the trial provided only advice about dietary modification, which was the usual care when the study began. However, doctors prescribed cholesterol-lowering drugs, when needed, for their patients in the usual care group.

Over the course of the trial, about 30 percent of participants in the usual care group received a cholesterol lowering drug. Comm Stat. Effect of vasodilator therapy on mortality in chronic congestive heart failure: results of a Veterans Administration Cooperative Study. N Engl J Med. Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension.

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Effect of single-drug therapy on reduction of left ventricular mass in mild to moderate hypertension: comparison of six antihypertensive agents. Alpha-blockade and thiazide treatment of hypertension: a double-blind randomized trial comparing doxazosin and hydrochlorothiazide. Changes in plasma volume and extracellular fluid volume after addition of prazosin to propranolol treatment in patients with hypertension. Scand J Clin Lab Invest. Vasodilators and regression of left ventricular hypertrophy: hydralazine versus prazosin in hypertensive patients.

Am J Med. Effect of age and hypertension on cardiac responses to the alpha1-agonist phenylephrine in humans. Arch Intern Med. Save Preferences. Privacy Policy Terms of Use. This Issue. Citations 1, View Metrics. Twitter Facebook More LinkedIn. Original Contribution. Continuing Medical Education. Study Design. Statistical Analysis. Patient Characteristics. Medication Adherence. Intermediate Outcomes. Primary and Secondary Outcomes. Access your subscriptions.

Access through your institution. Add or change institution. Free access to newly published articles. Total mortality did not differ between the doxazosin and chlorthalidone arms 4-year rates, 9. The doxazosin arm, compared with the chlorthalidone arm, had a higher risk of stroke RR, 1.

Considered separately, CHF risk was doubled 4-year rates, 8. Abstract Context: Hypertension is associated with a significantly increased risk of morbidity and mortality.

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