Blood pressure control by randomized drug group in allhat

The purpose of this presentation is to report the blood pressure (BP) control rates over time by randomized drug group and the proportion of participants controlled on one and two medications in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, active-controlled morbidity trial with an average follow-up of 5 years. Participant enrollment was from 2/94 to 3/02 in 623 centers in North America. Hypertensive patients (n=33,357, aged [≥]55 years) with [≥]1 other coronary heart disease risk factor were randomly assigned to receive one of 3 blinded study drugs, chlorthalidone (C), 12.5-25 mg/d (n=15,255), amlodipine (A) 2.5-10 mg/d (n=9,048), or lisinopril (L) 10-40 mg/d (n=9,054). Doses were increased and additional drugs from other classes were added as needed to achieve and maintain BP control (<140/90 mm Hg). At entry, mean age was 67 years, 47% were women, 35% were black, 36% had diabetes, 90% were on antihypertensive drug treatment, mean BP was 145/83 mm Hg, and the BP control rate was 27%. After 5 years, BP had been reduced to 134/76 mm Hg (C), 135/75 mm Hg (A), and 136/76 mm Hg (L); BP was controlled in 68% (C), 66% (A), and 61% (L); the mean number of drugs prescribed was 1.9(C), 2.0(A), and 2.1(L); only 26% overall and 28% (C), 24% (A), and 24% (L) of participants were controlled on 1 drug; and 24% (C), 26% (A), and 18% (L) were controlled on 2 drugs. Therefore, [≥]3 drugs would have been required to control BP in 48%, 50%, and 58% of participants randomized to the chlorthalidone, amlodipine, and lisinopril groups, respectively. These data show that BP was well controlled in the majority of participants in ALLHAT and average BP was well below 140/90 mm Hg for participants in each randomized group. More participants were controlled with chlorthalidone than the other two agents as monotherapy, although <30% of participants could be controlled on any of the drugs as a single agent. At least 2 medications were required for most participants to achieve BP control. These ALLHAT data support the recommendations of the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP (JNC 7) promoting multidrug regimens and the initial selection of thiazide-type diuretics for most patients to improve BP control rates.