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 lower cost of diuretics may justify their use provided there are no contraindications or express indications for another drug, but the superiority of diuretics has not been proved by the ALLHAT study.

To our knowledge, this analysis provides the first randomized comparison of different antihypertensive medications on risk of hip or dstudio fractures.

Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is unknown. We should point out that the incidence of coronary events in all groups is greater than expected.

Usable alhat Nephrology Cardiology. Risk of falls associated with antihypertensive medication: Data from randomized clinical trials are lacking.

PubMed Google Scholar Crossref. 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 addition, as in many large trials, only variables that were important to the primary goal of the study were collected; thus, we lacked allhay such as menstrual history womentestosterone levels menhistory of falls a proximate event in most hip and pelvic fracturesand bisphosphonate use.

In fact, use of atenolol together with chlorthalidone was associated with a nonsignificantly increased risk of fracture compared with use of chlorthalidone alone. The effect of angiotensin-converting enzyme inhibitor use on bone loss in elderly Chinese. But the study does not demonstrate the advantages of some combinations over others because we do not know what combination the patients received and, moreover, the combined drugs were administered in an open-label manner.


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.

Atenolol status at 1 month for the in-trial A and in-trial plus posttrial B cohorts. Thiazide for the postponement of postmenopausal bone loss.

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ALLHAT – Wiki Journal Club

The conditions are interrelated because people with hypertension have more osteoporotic fractures than people without hypertension. Hospitalized hip and pelvic fractures International Classification of Diseases, Ninth Revision eshudio, codes Study concept and design: Chlorthalidone use was associated with a significantly lower risk of fracture compared with lisinopril use HR, 0. Hip and Pelvic Fracture Cohorts.

Fourth, although randomization was generally well maintained during the allhst period, there was crossover of medication use. The groups were equally balanced in all aspects except that in-trial participants randomized to receive chlorthalidone had more baseline CHD alkhat the amlodipine and lisinopril groups The risk of hip fracture after initiating antihypertensive drugs in the elderly.

Journal of the American Medical Association. Study weaknesses should also be acknowledged. Our sample was based on participants who had been randomized to their treatment group, minimizing differences between the treatment groups.

Design and Conclusions of the ALLHAT Study | Revista Española de Cardiología (English Edition)

Thiazide diuretics and the risk of hip fracture. Recruitment was from February to January ; in-trial follow-up ended in March First, analyses, although performed in a randomized setting, were conducted post hoc, and results are subject to unmeasured bias. Purchase access Subscribe now. During the trial, fractures occurred.


J Bone Miner Res. Zuliani; Prince Edwards Island: Such ascertainment results in less underestimation of hip fracture incidence than methods based on self-report. Zyniecki; Investigators and Coordinators Canada: We were able to examine treatment effects for an extended period. Participants were randomly assigned to receive chlorthalidone, Thiazide diuretics and the risk for hip fracture.

During the entire trial and posttrial period of follow-up, the cumulative incidence of fractures was nonsignificantly lower in participants randomized to receive chlorthalidone vs lisinopril or amlodipine HR, 0.

Second, as a sensitivity analysis, we examined the cohort beginning 1 year after the onset of the study. Antihypertensive medications, bone mineral density, and fractures: Back to top Article Information. This effect is consistently observed in a variety of subgroups and appears to last for several years. In the cohort with in-trial and posttrial follow-up, 69 pelvic and hip fractures occurred during the in-trial and posttrial periods.

Sign in to customize your interests Sign in to your personal account. 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 take a thiazide diuretic.

Five-year systolic blood pressures were significantly higher in the amlodipine 0.