Original Papers. Success and Predictors of Blood Pressure Control in Diverse North American Settings: The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
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Context. Blood pressure control (<140/90 mm Hg) rates for hypertension fall far short of the US national goal of 50% or more. Achievable control rates in varied practice settings and geographic regions and factors that predict improved blood pressure control are not well identified. Objective. To determine the success and predictors of blood pressure control in a large hypertension trial involving a multiethnic population in diverse practice settings. Design. The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial is a randomized, double‐blind, active‐controlled clinical trial with a mean follow‐up of 4.9 years. Participant enrollment began in February 1994 and follow‐up was completed in March 2002. Setting. A total of 623 centers in the United States, Canada, and the Caribbean. Participants. A total of 33,357 participants (aged ≥55 years) with hypertension and at least one other coronary heart disease risk factor. Interventions. Participants were randomly assigned to receive (double‐blind) chlorthalidone, 12.5–25 mg/d (n=15,255), amlodipine 2.5–10 mg/d (n=9048), or lisinopril 10–40 mg/d (n=9054) after other medication was discontinued. Doses were increased within these ranges and additional drugs from other classes were added as needed to achieve blood pressure control (<140/90 mm Hg). Main Outcome Measures. The outcome measures for this report are systolic and diastolic blood pressure, the proportion of participants achieving blood pressure control (<140/90 mm Hg), and the number of drugs required to achieve control in all three groups combined. Results. Mean age was 67 years, 47% were women, 35% black, 36% diabetic; 90% were on antihypertensive drug treatment at entry. At the first of two pre‐randomization visits, blood pressure was <140/90 mm Hg in only 27.4% of participants. After 5 years of follow‐up, the percent controlled improved to 66%. Systolic blood pressure was <140 mm Hg in 67% of participants, diastolic blood pressure was <90 mm Hg in 92%, the mean number of drugs prescribed was 2.0±1.0, and the percent on ≥2 drugs was 63%. Blood pressure control varied by geographic regions, practice settings, and demographic and clinical characteristics of participants. Conclusions. These data demonstrate that blood pressure may be controlled in two thirds of a multiethnic hypertensive population in diverse practice settings. Systolic blood pressure is more difficult to control than diastolic blood pressure, and at least two antihypertensive medications are required for most patients to achieve blood pressure control. It is likely that the majority of people with hypertension could achieve a blood pressure <140/90 mm Hg with the antihypertensive medications available today.
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A disproportionately higher prevalence of resistant hypertension among blacks has been suggested to reflect a contribution by genetic factors, but environmental or psychosocial determinants of blood pressure control are also possible.
“A disproportionately higher prevalence of RH among blacks67,68 has been suggested to reflect a contribution by genetic factors, but environmental or psychosocial determinants of BP control are also possible.69”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [67]
Patients with chronic kidney disease and apparent treatment-resistant hypertension are at higher risk for cardiovascular disease events and renal events (50% decrease in estimated glomerular filtration rate or incident end-stage renal disease) compared with patients with chronic kidney disease without apparent treatment-resistant hypertension.
“Thus, patients with CKD and aTRH are at higher risk for CVD events and renal events (50% decrease in eGFR or incident end-stage renal disease) compared with patients with CKD without aTRH.67”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [67]
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- Authors
- Cushman, W. C., Ford, C. E., Cutler, J. A., Margolis, K. L., Davis, B. R., Grimm, R. H., Black, H. R., Hamilton, B. P., Holland, J., Nwachuku, C., Papademetriou, V., Probstfield, J., Wright, J. I., Alderman, M. H., Weiss, R. J., Piller, L., Bettencourt, J., Walsh, S. M., & For The ALLHAT Collaborative Research Group
- Affiliations
- United States Department of Veterans Affairs (US)
- Corresponding author
- Cushman, William C.
- ORCID
- Venue
- The Journal of Clinical Hypertension
- Publisher
- Wiley
- Published
- 2002-11
- Volume
- 4
- Issue
- 6
- Pages
- 393-404
- ISSN
- 1524-6175 (ISSN-L)
- 1751-7176
- OpenAlex
- W2404212513
- Cited by
- 979
- References
- 22
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 10 · 2023: 18 · 2022: 15 · 2021: 11 · 2020: 13 · 2019: 29 · 2018: 21 · 2017: 30 · 2016: 47 · 2015: 36 · 2014: 53 · 2013: 77 · 2012: 69
- FWCI
- 28.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- hypertension, blood pressure control, chlorthalidone, amlodipine, lisinopril, antihypertensive drugs, older adults, coronary heart disease risk, multi-ethnic population, practice environment, antihypertensive therapy, ALLHAT, regional variation, sex differences
- MeSH terms
- Aged, Antihypertensive Agents, Canada, Chlorthalidone, Double-Blind Method, Female, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, Risk Factors, United States, West Indies, Logistic Models, Treatment Outcome, Doxazosin, Amlodipine, Lisinopril
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