Hypertension and atherosclerosis: clinical implications from the ALLHAT Trial.
By failing to recognize the heterogeneity of hypertension, the authors of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study used a faulty premise to conduct a poorly designed clinical trial. By failing to control blood pressures equally across study drug groups, ALLHAT cannot be considered to be a definitive comparative trial. Being neither a monotherapy trial nor a trial that initiated therapy for blood pressure control, ALLHAT provided no data to recommend first-line therapy for hypertension, making the conclusions invalid. Thiazide-type diuretics increase angiotensin II and consequently promote atherosclerosis and arteriolarsclerosis. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers retard atherosclerosis and are nephroprotective. Multiple randomized controlled trials show beneficial clinical outcomes, including cardioprotection and nephroprotection, with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These agents, and not thiazide-type diuretics, should be used as first-line agents to retard the process of atherosclerosis and its clinical outcomes in the setting of arterial hypertension.
Standridge
John B
JB
Department of Family Medicine, University of Tennessee Health Science Center College of Medicine, 1100 E. 3rd Street, Chattanooga, TN 37403, USA. John.Standridge@erlanger.org.
D000804:Angiotensin II / Q000819:agonists / Q000097:blood; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001581:Benzothiadiazines; D001794:Blood Pressure / Q000187:drug effects; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects*; D013449:Sulfonamides; D015996:Survival Rate; D017211:Treatment Failure
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D013449:Sulfonamides; D000804:Angiotensin II
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