To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Chlorthalidone Superior To Doxazosin As First-Line Antihypertensive URL: http://www.pslgroup.com/dg/195A02.htm Doctor's Guide April 4, 2000
CHICAGO, IL -- April 4, 2000 -- Chlorthalidone, a diuretic, significantly reduces the risk of combined cardiovascular events in high-risk patients treated for hypertension (high blood pressure) compared with doxazosin, an alpha-blocker, according to a JAMA Express article posted on The Journal of the American Medical Association (JAMA) Web site (www.jama.com) on Tuesday, April 4, 2000. The article is scheduled to be published in print in the April 19, 2000, issue of JAMA. Barry R. Davis, M.D., Ph.D., from University of Texas-Houston, School of Public Health and colleagues writing for the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Collaborative Research Group report on the comparison of the effects of chlorthalidone and doxazosin for treatment of patients with hypertension. "ALLHAT results demonstrate that chlorthalidone is superior to doxazosin as a first-line antihypertensive drug in a diverse group of older hypertensive patients with other [cardiovascular disease - CVD] risk factors," the authors write. "However, the use of doxazosin as part of a multidrug regimen for treating hypertension alone or hypertension with symptoms of benign prostatic hypertrophy was not tested in this trial. Since ALLHAT was not a placebo-controlled trial but rather an active-controlled one, the study does not allow an assessment of whether doxazosin is better than placebo." The 42,448 patients included in the ALLHAT study were 55 years old or older with hypertension and at least one other coronary heart disease (CHD) risk factor (such as previous myocardial infarction or stroke, enlargement of the left ventricle of the heart, history of type 2 diabetes, current cigarette smoking, and low high-density lipoprotein cholesterol level). The patients, who were from 625 centers in the United States and Canada, were randomly assigned to receive one of four antihypertensive drugs: chlorthalidone, doxazosin, amlodipine (a calcium blocker) or lisinopril (an ACE inhibitor). The researchers found that mortality by any cause did not differ significantly between the patients assigned to receive either chlorthalidone (15,268 patients) or doxazosin (9,067 patients). They also found no significant difference in risk of death from CHD or experiencing a nonfatal myocardial infarction (MI) between the two treatment groups. There was a higher risk of stroke among the patients assigned to receive doxazosin compared with those assigned chlorthalidone. The risk of combined CVD events, which included death from CHD, nonfatal MI, stroke, revascularization procedures, angina, congestive heart failure (CHF) and peripheral arterial disease, was significantly reduced for patients assigned to chlorthalidone compared to doxazosin. The risk of combined cardiovascular disease outcomes was 25 percent higher for those in the doxazosin treatment group compared to the chlorthalidone treatment group. The risk of CHF was doubled for patients assigned to doxazosin compared to those assigned to chlorthalidone. The authors add that following independent data reviews, the Director of the National Heart, Lung, and Blood Institute (NHLBI) accepted a recommendation to discontinue the doxazosin treatment arm in the blood pressure component of the trial. "The decision to discontinue the doxazosin arm of the antihypertensive trial component was based on several factors. Foremost was a significantly higher incidence of combined CVD events and, in particular, CHF events, for the doxazosin group compared with the chlorthalidone group." Citing previous studies the authors note: "Heart failure affects nearly 4.6 million people in the United States, is a major cause of morbidity and mortality, and is the most common hospital discharge diagnosis among patients older than 65 years. In the Framingham Heart Study, 90 percent of heart failure cases were preceded by hypertension. In hypertensive patients especially, left ventricular hypertrophy [enlargement] is a common precursor of heart failure." (JAMA. 2000;283:1967-1975) Related Link: The Journal of the American Medical Association (JAMA). --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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