Do alpha blockers cause heart failure and stroke? Observations from ALLHAT

Abstract

The Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial (ALLHAT) is one of two current mega-trials (the other being the AngloScandinavian Cardiac Outcomes Study, ASCOT), with over 42 000 ‘high-risk’ antihypertensive patients with two objectives: firstly, to assess whether the newer antihypertensive agents (amlodipine, lisinopril, and doxazosin) reduce the incidence of coronary artery disease (CAD) when compared with a diuretic (chlorthalidone); and secondly, whether statin therapy in hypertensive patients with moderate hypercholesterolaemia will reduce cardiac events compared with placebo. Patients were randomised to one of the above four antihypertensive agents, with a planned follow-up of 4–8 years. On 24 January, 2000, the independent review committee recommended termination of the doxazosin arm on account of a 25% higher rate of the combined cardiovascular disease (CVD), a major secondary end-point, when compared to the patients taking chlorthalidone. The interim results were presented in March 2000 at the American College of Cardiology meeting in Anaheim, California, by Dr Barry Davis. The patients in both the doxazosin arm (n = 9067) and the chlorthalidone group (n = 15268) were very similar for baseline characteristics, and at 4 years, 86% of patients randomised to chlorthalidone were still taking the drug (vs 75% in the doxazosin arm). At 4 years, the mean systolic blood pressure was 135 mm Hg in the chlorthalidone group and 137 mm Hg in the doxazosin arm, with similar mean diastolic blood pressures. There was no difference in the relative risk (RR) of CAD between patients receiving doxazosin and those receiving chlorthalidone (RR 1.03; 95% CI 0.9–1.17), but the relative risk of combined CVD in the doxazosin arm compared with the chlorthalidone arm was 1.25 (95% CI 1.17–1.33; P , 0.0001), with the event curves diverging early. This effect was mainly related to an increased relative risk of heart failure in the patients taking doxazosin,

DOI: 10.1038/sj.jhh.1001038

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@article{Beevers2000DoAB, title={Do alpha blockers cause heart failure and stroke? Observations from ALLHAT}, author={D Gareth Beevers and Gyh Lip}, journal={Journal of Human Hypertension}, year={2000}, volume={14}, pages={287-289} }