The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) heart failure Validation Study: Diagnosis and prognosis

Einhorn, Paula T.; Davis, Barry R.; Massie, Barry M.; Cushman, William C.; Piller, Linda B.; Simpson, Lara M.; Levy, Daniel; Nwachuku, Chuke; Black, Henry R.

doi:10.1016/j.ahj.2006.10.012

Cited by 66 publications

(61 citation statements)

References 31 publications

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“…In addition, the Heart Failure Validation Study clearly confirmed the original observed treatment differences, on the basis of an independent central review that used both ALLHAT and Framingham criteria. 19 ALLHAT HF results appear to differ by time periods (Յ1 year and Ͼ1 year). At 1 year, HF incidence for lisinopril was double that of chlorthalidone, but this increased incidence diminished by year 6 to result in an overall 0.4% absolute difference throughout follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…16,17,19 The largest one, the Heart Failure Validation Study, reviewed almost all HF hospitalizations and deaths (3031 among 2091 patients) and all relevant material surrounding these events (including hospital records, death certificates, radiographic reports, and left ventricular ejection fraction measurements). 19 Specially trained cardiology fellows blinded to treatment assignment reviewed each case according to both ALLHAT and Framingham Heart Study criteria 20 and provided a global judgment as well. A more detailed report on this study is forthcoming.…”

Section: Discussionmentioning

confidence: 99%

“…HF validation study data showed that percentages of agreement with site physician diagnosis were 71%, 80%, and 84% for ALLHAT, Framingham Heart Study, and reviewers' judgment criteria, respectively. 19 In addition, treatment-group differences using confirmed cases were, if 13,19 Observed HF differences were larger earlier in the follow-up. The lisinopril group had a lower HF rate than the amlodipine group, but event curves did not separate until later.…”

Section: Early Divergence Of Hf Curvesmentioning

confidence: 99%

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Role of Diuretics in the Prevention of Heart Failure

et al. 2006

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Background-Hypertension is a major cause of heart failure (HF) and is antecedent in 91% of cases. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) stipulated assessment of the relative effect of chlorthalidone, lisinopril, and amlodipine in preventing HF. those individuals taking chlorthalidone versus amlodipine remained decreased but less so, whereas it was equivalent to those given lisinopril. Prior medication use, follow-up blood pressures, and concomitant medications are unlikely to explain most of the HF differences. Diuretics are superior to calcium channel blockers and, at least in the short term, angiotensin-converting enzyme inhibitors in Methods and Results-ALLHAT

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Early Divergence Of Hf Curvesmentioning

confidence: 99%

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Role of Diuretics in the Prevention of Heart Failure

et al. 2006

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“…35 Specifically, diuretic-based antihypertensive therapies have been shown to prevent HF in a wide range of target populations as first-line therapy. 27,[35][36][37][38][39] Additionally, low-dose diuretics have been shown to be more effective as a first-line treatment for preventing the development of HF compared with ACE inhibitors, β-blockers, or calcium channel blockers by meta-analysis. 38 It should also be noted that most of the original trials used the longer-acting chlorthalidone rather than hydrochlorothiazide.…”

Section: Medication Choices For the Treatment Of Hypertension To Prevmentioning

confidence: 99%

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

Bozkurt¹,

Aguilar²,

Deswal³

et al. 2016

Circulation

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CLINICAL STATEMENTS AND GUIDELINESfailed to show a significant reduction of SBP in patients with resistant hypertension. 81 Other strategies such as targeting excessive sympathetic nerve activity by carotid body denervation are awaiting clinical validation in the hypertension and HF populations. Drugs to Avoid in Patients With HFSeveral classes of drugs should be avoided in patients with HFrEF with a history of hypertension. Because of their negative inotropic properties and the increased likelihood of worsening HF symptoms, the nondihydropyridine calcium channel blockers such as diltiazem and verapamil should be avoided. 8 The dihydropyridine calcium channel blocker amlodipine appeared to be safe in patients with severe HFrEF in the PRAISE trial (Prospective Randomized Amlodipine Survival Evaluation), 82 as was felodipine. 73 In the current 2013 HF guidelines, most calcium channelblocking drugs except amlodipine are not recommended. 8Although clonidine is an effective antihypertensive agent, a similar centrally acting drug, moxonidine, was associated with increased mortality in patients with HF; thus, centrally acting norepinephrine-depleting agents may need to be avoided or used with caution in patients with HFrEF. 83In the ALLHAT trial, the α-blocker doxazosin arm of the trial was discontinued because of a 2-fold increase in the risk of developing HF compared with chlorthalidone treatment. 45 Although the ALLHAT study excluded patients with established HF and there are caveats about extrapolating these data to the management of hypertension in patients with established HF, the safety and efficacy of α-blockers in the management of patients with HF with hypertension are currently unclear. Potent direct-acting vasodilators such as minoxidil should also be avoided because of their renin-related salt and fluid-retaining effects. Nonsteroidal anti-inflammatory agents should be used with caution in these patients, given their effects on BP, volume status, and renal function. Treatment of Hypertension in Patients With HF With Preserved LVEFMost patients with HF and preserved LVEF (HFpEF), especially elderly women, have hypertension. A significant proportion of these patients also have evidence of LV hypertrophy, and some may have atrial dilatation, cardiac enlargement, and wall motion abnormalities without LV systolic dysfunction. Patients with HFpEF may respond particularly well to the treatment of hypertension with regression of hypertrophy 84 and improvement in filling pressures. 84,85 Most patients with HFpEF require treatment with cardiac medications for the comorbidities of hypertension, diabetes mellitus, coronary artery disease, and atrial fibrillation. The 2013 HF guidelines suggest that the use of β-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control BP in patients with HFpEF. 8 The use of ARBs might also be considered to decrease hospitalizations for patients with HFpEF. recommendations Harmonized With Existing Guidelines for the recognition and Treatment of pa...

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“…16 In the Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial (ALLHAT), an unplanned crossover occurred in more than 20% of patients. 17 As the analysis of trial data is performed by 'intention-to-treat', this reduces the actual treatment differences between groups, and consequently the chance of outcome differences. Other limitations include the short-term duration of trials (usually around 3-5 years) and the inclusion of nonresponders, that is, patients in whom the drug has no blood pressure effect.…”

Section: Clinic Versus Ambulatory Blood Pressure Controlmentioning

confidence: 99%