The Journal of Informed Pharmacotherapy 2002;9:151
Reviewer: James McCormack, B.Sc. (Pharm), Pharm. D.
Reviewer's email address: email@example.com
Reviewer's profession/specialty: Professor, Faculty of Pharmaceutical Sciences, University of British Columbia
Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group. JAMA 2000;283:1967-75. PubMed Citation
These investigators evaluated the differences in long-term outcomes when hypertensive patients were treated with either doxazosin or chlorthalidone.
24,335 patients mean age 67 (47% women) with hypertension (>140/90) and at least one other coronary heart disease risk factor.
Chlorthalidone 12.5 or 25 mg po daily versus doxazosin 2,4, and 8 mg po daily.
The doxazosin arm was stopped early after 3.3 years.
|Fatal and nonfatal MI (%)||All deaths (%)||CHD death, non-fatal MI, revascularization, and angina (%)||CHF (%)||Strokes (%)|
|Relative Risk Reduction||NSS||8||44||31|
|Absolute Risk Reduction||1.1||3.6||0.6|
|NNT/NNH over 3.3 years||91||28||167|
NNT = numbers needed to treat, NNH = numbers needed to harm, NSS = not statistically significant
Systolic blood pressure was approximately 2-3 mmHg lower in the chlorthalidone group, thre was no difference in the diastolic blood pressure between groups. Cholesterol was 0.2 mmol/L lower, potassium was 0.4 mmol/L higher, and mean serum glucose was 0.2 mmol/L lower in the doxazosin group.
This study shows that despite similar changes in surrogate markers, chlorthalidone patients had fewer CHD death, non-fatal, MI, revascularization, and angina (1.1% absolute difference), CHF (3.6 % absolute difference) and strokes (0.6% absolute difference) than patients treated with doxazosin.
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