home Accueil > Essais thérapeutiques > ALLHAT

ALLHAT

23 juin 2016

ALLHAT? : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

L’étude ALLHAT est un méga-essai thérapeutique randomisé contrôlé en double aveugle. Le but était de comparé les nouveaux antihypertenseurs IEC?, BCC?, alpha-bloqueur à un diurétique thiazidique (chlorthalidone) avec un suivi de 8 ans. Le critère principal d’évaluation comninait les événements coronariens d’issue fatale, les infarctus du myocarde d’issue fatale et non fatale. Il n’a pas été observé de différence entre les différents groupes à l’exception de l’alpha-bloqueur (doxasozine) bras d’essai thérapeutique interrompu prématurément en raison d’un excès de risque? coronarien, d’insuffisance cardiaque et d’AVC?.

Cette étude a fait conclure à l’absence de bénéfice supplémentaire apporté par les nouveaux antihypertenseurs comparé au diurétique thiazidique. Les limites méthodologiques ont été maintes fois débattues, dominées par l’utilisation d’associations thérapeutiques peu logiques, discréditant notamment l’IEC, l’existence d’une différence de pression artérielle sous traitement entre les trois groupes, l’arrêt des médicaments antérieurs sans période de lavage (wash-out). Ce résultat est à la base des recommandations américaines prônant l’utilisation du diurétique thiazidique en première intention.

Ref.

ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs? diuretic : The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002 ;288(23):2981-97. pdf12479763

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care : The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002 ;288(23):2998-3007. pdf12479764

Kronish IM, Lynch AI, Oparil S, Whittle J, Davis BR, Simpson LM, Krousel-Wood M, Cushman WC, Chang TI, Muntner P. The Association Between Antihypertensive Medication Nonadherence and Visit-to-Visit Variability of Blood Pressure : Findings From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Hypertension. 2016 Jul ;68(1):39-45. pdf27217410

Muntner P, Davis BR, Cushman WC, et al ; ALLHAT Collaborative Research Group. Treatment-resistant hypertension and the incidence? of cardiovascular disease and end-stage renal disease : results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension. 2014 Nov ;64(5):1012-21. pdf25259745

Yamal JM, Oparil S, Davis BR, et al. ; ALLHAT Collaborative Research Group. Stroke outcomes among participants randomized to chlorthalidone, amlodipine or lisinopril in ALLHAT. J Am Soc Hypertens. 2014 Nov ;8(11):808-19. pdf25455006

Whittle J, Yamal JM, Williamson JD, et al. ; ALLHAT Collaborative Research Group.Clinical and demographic correlates of medication and visit adherence in a large randomized controlled trial. BMC Health Serv Res. 2016 Jul 8 ;16(1):236. pdf27391223

Whittle J, Lynch AI, Tanner RM, et al. Visit-to-Visit Variability of BP and CKD Outcomes : Results from the ALLHAT. Clin J Am Soc Nephrol. 2016 Mar 7 ;11(3):471-80. pdf26912544

Muntner P, Whittle J, Lynch AI, et al. Visit-to-Visit Variability of Blood Pressure and Coronary Heart Disease, Stroke, Heart Failure, and Mortality : A Cohort Study. Ann Intern Med. 2015 ;163(5):329-38. pdf26215765

Reisin E, Graves JW, Yamal JM, et al. ; ALLHAT Collaborative Research Group.Blood pressure control and cardiovascular outcomes in normal-weight, overweight, and obese hypertensive patients treated with three different antihypertensives in ALLHAT. J Hypertens. 2014 ;32(7):1503-13 ; discussion 1513. pdf24842697

Rahman M, Ford CE, Cutler JA, et al. ; ALLHAT Collaborative Research Group. Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR. Clin J Am Soc Nephrol. 2012 (6):989-1002. pdf22490878

Barzilay JI, Davis BR, Pressel SL, et al. ; ALLHAT Collaborative Research Group. Long-term effects of incident diabetes mellitus on cardiovascular outcomes in people treated for hypertension : the ALLHAT Diabetes Extension Study. Circ Cardiovasc Qual Outcomes. 2012 ;5(2):153-62. pdf22396585

Onuigbo MA. ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses. Arch Intern Med. 2009 Oct 26 ;169(19):1810 ; author reply 1810-1. pdf19858442

Cushman WC, Ford CE, Einhorn PT, et al. ; ALLHAT Collaborative Research Group.Blood pressure control by drug group in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens. 2008 Oct ;10(10):751-60. pdf19090876

Davis BR, Piller LB, Cutler JA, et al. ; Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group.Role of diuretics in the prevention of heart failure : the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Circulation. 2006 May 9 ;113(18):2201-10. Epub 2006 May 1. pdf16651474

Rahman M, Pressel S, Davis BR, et al. ; ALLHAT Collaborative Research Group. Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med. 2006 Feb 7 ;144(3):172-80. pdf16461961

Rahman M, Pressel S, Davis BR, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic : a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 2005 Apr 25 ;165(8):936-46. pdf15851647

Rahman M, Brown CD, Coresh J, et al. ; Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. The prevalence of reduced glomerular filtration rate in older hypertensive patients and its association with cardiovascular disease : a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Arch Intern Med. 2004 May 10 ;164(9):969-76. pdf15136305

Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Diuretic versus alpha-blocker as first-step antihypertensive therapy : final results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension. 2003 Sep ;42(3):239-46. pdf12925554

Cushman WC, Ford CE, Cutler JA, et al. ; ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings : the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens (Greenwich). 2002 Nov-Dec ;4(6):393-404. pdf12461301

Piller LB, Davis BR, Cutler JA, et al. ; The ALLHAT Collaborative Research Group. Validation of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants Assigned to Doxazosin and Chlorthalidone. Curr Control Trials Cardiovasc Med. 2002 Nov 14 ;3(1):10. pdf12459039

Davis BR, Cutler JA, Furberg CD, Wright JT, Farber MA, Felicetta JV, Stokes JD ; ALLHAT Collaborative Research Group. Relationship of antihypertensive treatment regimens and change in blood pressure to risk for heart failure in hypertensive patients randomly assigned to doxazosin or chlorthalidone : further analyses from the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial. Ann Intern Med. 2002 Sep 3 ;137(5 Part 1):313-20. pdf12204014

Grimm RH Jr, Margolis KL, Papademetriou V V, et al. Baseline Characteristics of Participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension. 2001 ;37(1):19-27. pdf11208751

ALLHAT Collaborative Research Group. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone : the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA. 2000 ;283(15):1967-75. Erratum in : JAMA 2002 ;288(23):2976. pdf10789664