Published in , the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) sought to determine which of. Request PDF on ResearchGate | On Jul 1, , José Ramón González- Juanatey and others published Después del estudio ALLHAT, ¿qué sabemos de lo que. Después del estudio ALLHAT, ¿qué sabemos de lo que desconocíamos sobre el and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

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Calls from Spain 88 87 40 9 to 18 hours. Our website uses cookies to enhance your experience. One year after the thiazide use was stopped, there was no difference in BMD compared with the placebo group, suggesting rapid loss of the beneficial effect of the diuretic. Despite these caveats, participants randomized to receive chlorthalidone during the in-trial period continued to have a lower point estimate of fracture risk 5 years after study completion, suggesting but not proving a legacy effect.

Design and Conclusions of the ALLHAT Study | Revista Española de Cardiología (English Edition)

This page was last modified on 14 Septemberat The groups were equally balanced in all aspects except that in-trial participants randomized to receive chlorthalidone had more baseline Allhaat than the amlodipine and lisinopril groups Back to top Article Information. The effect of angiotensin-converting enzyme inhibitor use on bone loss in elderly Chinese.

The interpretation of the differences for the secondary objectives does not consider the complexity of treatment, and the comparison is based on the initial randomization group, which does not ensure that the patient received the corresponding drug. Antihypertensive medications, bone estudlo density, and fractures: During the trial, fractures occurred. No specific funding was allocated for the work presented in this article.

In sensitivity analyses, when 1 year after randomization was used as the baseline to allow for the effects of medications on bone to take effectsimilar results were obtained for in-trial and in-trial plus posttrial follow-up.

Design and Conclusions of the ALLHAT Study

Heterogeneity was assessed for age, race, sex, diabetes, eGFR, incident and prevalent CVD, body mass index, smoking, and for females hormone replacement therapy. Three of these individuals had both hip and pelvic fractures. For this secondary analysis, which used an intention-to-treat approach, data were analyzed from February 1,through December 31, For the initial curves A and Bin the in-trial cohort, the unadjusted hazard ratio HR was 0. Journal of the American Medical Association.


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Given these results and the widespread use of ACEis for the treatment of hypertension in older adults, our finding has potentially important public health implications. Recruitment was from February 1,through January 31, ; in-trial follow-up ended March 31, Purchase access Subscribe now. Iberoamerican Cardiovascular Journals Editors’ Network.

Hip and Pelvic Fracture Cohorts. First, we examined the cohort from the time of randomization until the time of event fracture or censoring death or end of follow-upthus maintaining the randomized allocation of participants.

Second, participation in ALLHAT excluded several groups of participants at high risk for fracture, such as those with active coronary artery disease and heart failure 1028 and chronic kidney disease. For the primary analyses, we combined those separately assigned to amlodipine and lisinopril into 1 group for greater statistical power. We asked 3 questions: Sign in to access your subscriptions Sign in to your personal account. However, a higher risk of fracture or lower BMD in ACEi users has not been a universal finding, and some studies 1011 report a protective effect of renin angiotensin blockade.

Acquisition, analysis, or interpretation of data: To our knowledge, this analysis provides the first randomized comparison of different antihypertensive medications on risk of hip or pelvic fractures. Prescribing patterns for thiazide diuretics in a large health maintenance organization: Create a free personal account to download free article PDFs, sign up for alerts, and more.

Cardiovascular Medications and Fractures.

These fracture types are well captured in administrative data sets and are serious fracture types that can be associated with mortality. Fracture rates and graphs used the Kaplan-Meier method. Assuming a beneficial effect in the chlorthalidone group during the trial, would this pattern continue during the posttrial period ie, is there a legacy effect? Views Read View source View history.

Such crossover would tend to decrease differences in fracture outcomes between medication classes. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Secondary outcomes were all-cause mortality, stroke, combined CHD primary outcome, coronary revascularization, or angina with hospitalizationand combined CVD combined CHD, stroke, treated angina without hospitalization, heart failure [HF], and peripheral arterial disease. The estduio drug was instituted and additional open-label agents were added to achieve BP goals.


The VA esstudio files were not available for the posttrial follow-up ; therefore, the posttrial cohort was limited to US citizens with Medicare Part A insurance at randomization Figure 1.

ALLHAT – Wiki Journal Club

Analyses were repeated beginning 1 year after randomization to gauge the effects of the medications on fracture risk after trial participants had been exposed to the bone effects of the medications for 1 year. The in-trial cohort consisted of participants randomized to chlorthalidone, amlodipine, or lisinopril, with or without atenolol at month 1 of follow-up from baseline Figure 1 A.

Hospitalized hip and pelvic fractures International Classification of Diseases, Ninth Revisioncodes J Clin Hypertens Greenwich. Critical revision of the manuscript for important intellectual content: A total of 33 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from North American centers.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT was a large randomized clinical trial that compared the effect of first-step therapy with different classes of antihypertensive drug therapy in preventing fatal coronary heart disease CHD or nonfatal myocardial infarction primary outcome and other cardiovascular disease CVD events. If goal estuio pressure was not achieved using the maximum tolerated dose, open-label step 2 reserpine, clonidine, or esturio or step 3 hydralazine medications could be added.

Risk of fracture was significantly lower in participants randomized to receive chlorthalidone vs lisinopril HR, 0. Moreover, the use of bisphosphonates became common only in the early s, after the release of several large fracture trials.