title: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): clinical center recruitment experience.
abstract: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a randomized clinical outcome trial of antihypertensive and lipid-lowering therapy in a diverse population (including substantial numbers of women and minorities) of 42,419 high-risk hypertensives aged > or = 55 years with a planned mean follow-up of 6 years. In this paper, we describe our experience in the identification, recruitment, and selection of clinical centers for this large simple trial capable of meeting the recruitment goals outlined for ALLHAT, and we highlight factors associated with clinical center performance. Over 135,000 recruitment brochures were mailed to physicians. Requests for information and application packets were received from 9351 (6.8%) interested investigators. A total of 1053 completed applications were received and 909 sites (86%) were eventually approved to join the trial. Of the approved sites, 278 either later declined participation or were never activated, and 8 were closed within a year for lack of enrollment. The final 623 randomizing centers exceeded the trial's recruitment goal to enroll at least 40,000 participants into the trial, although the recruitment period was extended 1.5 years longer than planned. Fewer than a quarter of the sites (22.6%) were recruited from academic medical centers or Department of Veterans Affairs Medical Centers. More than half of the sites (54.7%) were private solo or group practices, which contributed 53% of randomized participants. Community health centers comprised about 8% of the ALLHAT sites and 2.9% were part of health maintenance organizations. More than 22% of the principal investigators reported that they had no previous clinical research experience. In summary, ALLHAT was successful in recruiting a diverse group of clinical centers to achieve its patient recruitment goals.
authors.affiliation: Clinical Hypertension Program, Division of Hypertension, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106-4982, USA. jxw20@po.cwru.edu
authors.forename: J T
authors.initials: JT
authors.lastname: Wright
authors.forename: W C
authors.initials: WC
authors.lastname: Cushman
authors.forename: B R
authors.initials: BR
authors.lastname: Davis
authors.forename: J
authors.initials: J
authors.lastname: Barzilay
authors.forename: P
authors.initials: P
authors.lastname: Colon
authors.forename: D
authors.initials: D
authors.lastname: Egan
authors.forename: T
authors.initials: T
authors.lastname: Lucente
authors.forename: C
authors.initials: C
authors.lastname: Nwachuku
authors.forename: S
authors.initials: S
authors.lastname: Pressel
authors.forename: F H
authors.initials: FH
authors.lastname: Leenen
authors.forename: J
authors.initials: J
authors.lastname: Frolkis
authors.forename: R
authors.initials: R
authors.lastname: Letterer
authors.forename: S
authors.initials: S
authors.lastname: Walsh
authors.forename: J N
authors.initials: JN
authors.lastname: Tobin
authors.forename: G E
authors.initials: GE
authors.lastname: Deger
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000517:prevention & control*; D010560:Personnel Selection / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014481:United States; D001741:Black or African American
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents