Medliorate

Improving medical students

The Impact of ALLHAT

Posted by medliorator on March 12, 2009

Andrew Pollack:

Allhat [Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial] began enrolling patients with high blood pressure, age 55 and older, in 1994, with more than 42,000 people eventually participating.

patients receiving the Norvasc [CCB, Pfizer] had a 38 percent greater incidence of heart failure than those on the diuretic. And those receiving the ACE inhibitor… had a 15 percent higher risk of strokes and a 19 percent higher risk of heart failure.

The percentage of hypertension patients receiving a diuretic rose to around 40 percent in the year after the Allhat results were announced, up from 30 to 35 percent beforehand, according to some studies. But use of diuretics has since stayed at that plateau. And over all, use of newer hypertension drugs has grown faster than the use of diuretics since 2002

The aftereffects of the study show how hard it is to change medical practice, even after a government-sanctioned trial costing $130 million produced what appeared to be solid evidence.

A confluence of factors blunted Allhat’s impact. One was the simple difficulty of persuading doctors to change their habits. Another was scientific disagreement

Even before Allhat was finished, and certainly since then, new drugs appeared. Others, meanwhile, became available as generics, reducing the cost advantage of the diuretics. And many doctors have shifted to using two or more drugs together

So Allhat’s main query — which drug to use first — became “an outdated question that doesn’t have huge relevance to the majority of people’s clinical practices,” said Dr. John M. Flack, the chairman of medicine at Wayne State University

The Minimal Impact of a Big Hypertension Study [NYT]

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