Acronym: The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial
Purpose: Evaluated chlorthalidone versus amlodipine versus lisinopril in patients with hypertension and coronary risk factors
Format: Randomized, double-blind, active-controlled
Treatment Group 1: chlorthalidone, 12.5 to 25 mg/d
Treatment Group 2: amlodipine, 2.5 to 10 mg/d
Treatment Group 3: lisinopril, 10 to 40 mg/d
Number of Patients: 33,357
- 55 years or older
- At least 1 other CHD risk factor
Primary Endpoint: composite endpoint of fatal coronary heart disease or nonfatal MI
- All-cause mortality
- Combined CHD (primary outcome, coronary revascularization, or angina with hospitalization)
- Combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure, and peripheral arterial disease)
Follow-up: Mean, 4.9 years
The primary composite endpoint of fatal coronary heart disease or nonfatal MI was similar in the three groups. Chlorthalidone improved blood pressure the best, reduced stroke, cardiovascular disease and heart failure better than lisinopril, and reduced heart failure diagnosis better than amlodipine. Only 30% of patients achieved goal blood pressure control on one agent. There was a doxazosin arm which was stopped early due to an increase in the primary endpoint and twice the risk of developing heart failure versus chlorthalidone. A subgroup evaluated pravastatin 40 mg PO daily which did not show any mortality benefit despite lowering LDL cholesterol levels (small study).
Furberg CD, et al. JAMA. 2002; doi:10.1001/jama.288.23.2981.