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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The groups were equally balanced in all aspects except that in-trial allhqt randomized to receive chlorthalidone had more baseline CHD than the amlodipine and lisinopril groups Low dose beta-blocker prevents ovariectomy-induced bone loss in rats without affecting heart functions.
The authors outside the Coordinating Center did not have access to participant-level identifying data. No significant difference was found between those taking or not taking atenolol.
All participants gave written informed consent, and all centers obtained institutional review board approval for the trial. Estimating equations for glomerular filtration rate in the era of creatinine standardization: Among all participants, 9.
Recruitment was from February 1,through January 31, ; in-trial follow-up ended March 31, The unadjusted HR for atenolol users was 1. Outcomes analysis used an intention-to-treat approach. Our analyses based on posttrial and in-trial experience were not based estudjo a randomized comparison and thus are subject to bias.
ALLHAT – Wiki Journal Club
The risk of hip fracture after initiating antihypertensive drugs in the elderly. First, we examined the cohort from the time of randomization until the time of event fracture or censoring death or end of follow-upthus estudii the randomized allocation of participants.
The primary outcome occurred in participants, with no difference between treatments. Moreover, the use of bisphosphonates became common only in the early s, after the release of several large fracture trials.
Heterogeneity was assessed for age, race, aallhat, diabetes, eGFR, incident and prevalent CVD, body mass index, smoking, and for females hormone replacement therapy. The fracture rates were somewhat higher than in the in-trial cohort, likely because of the older age of the cohort with extended follow-up. A logical interpretation of this finding is to accept the null hypothesis and claim that the new drugs are not superior to diuretics, and indeed this is stated in the commentary section of the ALLHAT study.
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. In a prospective cohort study 12 of older men from the Osteoporotic Fractures in Men Study, with 4.
Wright JT, et al. The VA data 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. Although this approach is highly accurate for diagnosing fractures, 23 participants eligible for Medicare who were enrolled in managed care would not have hospitalizations recorded with Medicare, thereby lowering the number of participants with fractures.
Usable articles Nephrology Cardiology. The large alhlat size, estudlo follow-up, and randomized therapy provide a unique opportunity to examine post hoc the effects of the major classes of blood pressure—lowering medications on the incidence of hospitalizations for hip and pelvic fractures.
Given that atenolol was used as an add-on medication in ALLHAT, this finding should be viewed with a great deal of caution. Risk of fracture was significantly lower in participants randomized to receive chlorthalidone vs lisinopril HR, 0.
Design and Conclusions of the ALLHAT Study
Several clinical studies suggest lower fracture risk with their use, 1011 although not all studies agree. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, eatudio approval of the manuscript; and the decision to submit the manuscript for publication.
The authors’ argument that this does not influence coronary events may be fallacious because the follow-up is too short for this influence to become apparent. High blood pressure and bone-mineral loss in elderly white women: 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 allhwt or lisinopril.
The Rotterdam study 18 reported that the presumed hip fracture protective effect of thiazides disappeared 4 months after discontinuation of aallhat therapy. Ford, PhD, Linda B. Esrudio hip and pelvic fractures International Classification of Diseases, Ninth Revisioncodes Similar results were obtained in sensitivity analyses, where the first year of follow-up after randomization was excluded.
Surprisingly, the authors then conclude that thiazide diuretics should be the initial treatment in arterial hypertension and should be used, if possible, in association with antihypertensive agents. Bone mineral density changes among women initiating blood pressure lowering drugs: The optimal choice of antihypertensive for prevention of CAD endpoints was unclear.
The primary outcome was combined fatal CHD or nonfatal myocardial infarction, analyzed by intent-to-treat. Fully adjusted hip and pelvic fracture HRs, stratified by selected variables, are shown for the in-trial cohort in Figure 3 and eFigure 3 in the Supplement.
Design and Conclusions of the ALLHAT Study | Revista Española de Cardiología (English Edition)
A total of 33 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from North American centers.
Thirty-four participants had pelvic fractures and participants had hip fractures during the in-trial period mean [SD] follow-up, 4. JAMA Jan 8; 2: 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.
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 levels menhistory of falls a proximate event in most hip and pelvic fracturesand bisphosphonate use.
Three of these individuals had both hip and pelvic fractures. Special recognition is due to 3 ALLHAT leaders who died after making very significant contributions to initiating the trial and overseeing most of its course: Study concept and design: 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.