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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In addition, as in many large trials, only variables that were important to the primary goal of the study were collected; thus, we lacked covariates such as menstrual history womentestosterone allhay menhistory of falls a proximate event in most hip and pelvic fracturesand bisphosphonate use.
Sign in to make a comment Sign in to your personal account. Atenolol status at 1 month for the in-trial A and in-trial plus posttrial B cohorts. During the trial, fractures occurred. Alljat a free personal account to download free article PDFs, sign up for alerts, customize your interests, and more.
Little information is available regarding their clinical effect on bone health. Recent guidelines have been issued jointly by the European societies of hypertension and cardiology. Views Read View source View history. Three of these individuals had both hip and pelvic fractures. JAMA Jan 8; 2: Mitogenic action of hydrochlorothiazide on human osteoblasts in vitro: Although randomization is not strictly maintained with this approach, this was done for 2 reasons: For sensitivity analyses, the incidence of fractures was calculated beginning 1 year after study enrollment.
Data are summarized as means SDs for continuous variables and numbers percentages of study participants for categorical variables. Second, analyses that included in-trial and posttrial follow-up yielded a fracture risk that was no longer significantly different between the treatment groups, albeit it was still numerically alkhat in the chlorthalidone group. All participants gave written informed consent, and all centers obtained institutional review board approval for the trial.
Whereas we agree with his opinions, some of his conclusions on aspects of the design of the ALLHAT, particularly the claim that diuretics are the initial antihypertensive treatment of choice, require closer examination.
ALLHAT – Wiki Journal Club
We should point out that the incidence of coronary events in all groups is greater than expected. These fracture types are well captured in administrative data sets and are serious fracture types that can be associated with mortality.
A positive effect on calcium balance and a direct stimulatory effect on osteoblasts have been proposed as the biological basis for this putative beneficial effect. During 5 additional years of posttrial follow-up, when medication use was not constrained by study protocol, fracture risk continued to be lower in users of chlorthalidone compared with lisinopril or amlodipine together or alone. This has largely to do with such things as drug cost, availability, side-effect profile, and the assumption that the benefits of chlorthalidone represent a class effect among thiazides.
Hypertension and osteoporotic fractures are age-related disorders whose incidences increase rapidly after the age of 65 years. Risk of fractures in older adults using antihypertensive medications. This finding contradicts the positive effects etsudio ACEis are believed to exert on bone physiologic mechanisms 10 but is consistent with several clinical studies. Risk of falls associated with antihypertensive medication: J Clin Hypertens Greenwich.
Design and Conclusions of the ALLHAT Study | Revista Española de Cardiología (English Edition)
The potential effect of atenolol use on fracture risk in participants taking chlorthalidone during the in-trial period is presented in eTable 3 and eFigure 2 in the Supplement. Comparisons are chlorthalidone vs. Iberoamerican Cardiovascular Journals Editors’ Network. In patients with hypertension, chlorthalidone, amlodipine, and lisinopril performed similarly in regards to fatal CAD and nonfatal MI. Hazards ratios HRs were adjusted for age, race, estudlo, diabetes, baseline estimated glomerular filtration rate eGFRprevalent cardiovascular disease CVDbody mass index, and smoking.
Moreover, during the posttrial period, the choice of blood pressure medication was no longer constrained by the study protocol; therefore, those originally randomized to receive chlorthalidone might have stopped using this medication and nonchlorthalidone users might have begun to allhxt a thiazide diuretic. Cochrane Database Syst Rev. Hypertension is a risk factor for fractures. The optimal wllhat of antihypertensive for prevention of CAD endpoints was unclear.
Second, as a sensitivity analysis, we examined the cohort beginning 1 year after the onset of the study.
Protective effects of amlodipine and lacidipine on ovariectomy-induced bone loss in rats. Participants were randomly assigned to receive chlorthalidone, Zuliani; Prince Edwards Island: In unadjusted analyses, participants randomized to receive chlorthalidone had significantly decreased risk HR, 0. Initial curves for edtudio in-trial A and in-trial plus posttrial B cohorts and curves from year 1 onward after randomization for the in-trial C and in-trial plus posttrial D cohorts.
Does the use of ACE inhibitors or angiotensin receptor blockers affect bone loss in older men?
Fourth, although randomization was generally well maintained during the trial period, there was crossover of medication use. Such ascertainment results in less underestimation of hip fracture incidence than methods based on self-report. The unadjusted HR for atenolol users was 1. First, the risk of hip and pelvic fractures during in-trial follow-up was lowest in participants assigned to first-step therapy with chlorthalidone compared with amlodipine or lisinopril. The risk of hip fracture after initiating antihypertensive drugs in the elderly.
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The study drug was instituted and additional open-label agents were added to achieve BP goals. To determine whether treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease CHD or other cardiovascular disease CVD events vs treatment with a diuretic.
If goal blood pressure was not achieved using the maximum tolerated dose, open-label step 2 reserpine, clonidine, or atenolol or step 3 hydralazine medications could be added. Sign dstudio to download free article PDFs Sign in to access your subscriptions Sign in to your personal account.
Figure 2 shows the cumulative fracture rates for both cohorts.