Paul Whelton, M.D., M.Sc.
ALLHAT Steering Committee
Professor of Epidemiology and Medicine
Tulane University Health Sciences Center
New Orleans, Louisiana
December 17, 2002
Press Conference Remarks
Release of the Results of the Antihypertensive and Lipid -Lowering Treatment to Prevent Heart Attack Trial: Implications for Health Care Professionals and the Public
The ALLHAT findings have important implications for the 50 million Americans who have high blood pressure, for the health care providers who treat them, and for the insurers and individuals who pay for the medications used to treat hypertension.
For health care providers, ALLHAT provides clear results regarding the best drug to prescribe when starting hypertension therapy. Diuretics were superior in lowering blood pressure and preventing hypertension-related complications, and they had few side effects. A bonus is that diuretics are inexpensive--just a few cents per pill.
The ALLHAT results mean that each time a health care provider sees a person with high blood pressure, he or she should review that patient's treatment regimen to determine whether they are receiving the optimal combination of lifestyle and drug therapy. Diuretics should be used as the initial form of drug therapy in patients who are not already taking medication to lower their blood pressure. For patients whose high blood pressure is already being treated with a medication other than a diuretic, physicians should consider switching to a thiazide-type diuretic or adding diuretics to the existing regimen. In making this decision, physicians will need to take into consideration other conditions the patient may have that could influence drug choice, such as angina pectoris.
The ALLHAT results are important news for everyone being treated for hypertension. If you are currently taking high blood pressure medication, you should not stop your treatment regimen on your own. Rather, consult with your health care provider about the appropriateness of your current medications in light of the ALLHAT results. If you need to begin drug treatment to lower your blood pressure, diuretics should almost always be the first choice. If you are already being treated for high blood pressure, talk with your doctor to be sure it's under adequate control-it should be below 140/90 mm Hg. If you need more than one medication to control your blood pressure--and many people do--one should be a diuretic. And don't forget, even if you're on medication, a key part of your treatment is lifestyle changes. Be physically active; lose weight if necessary; follow an eating plan that's low in saturated fat, cholesterol, and salt, and high in potassium; and don't smoke.
The ALLHAT hypertension results are good news for health care insurers and for the millions of patients without drug coverage who bear the burden of paying for their own medications. In comparing diuretics with newer, more costly medications, ALLHAT showed that diuretics were superior, both medically and economically. This gives policymakers, health care insurers, and those who develop treatment guidelines the green light to recommend the most effective, lowest cost option for starting hypertension treatment. The ALLHAT findings give patients the reassurance that their hypertension can be controlled effectively at a lower cost. For those without drug coverage, using a pill that costs only pennies a day can mean the difference between treating their condition or suffering the deadly consequences of uncontrolled hypertension.
ALLHAT also included a cholesterol-lowering study that looked at the effects of the statin drug pravastatin compared to "usual care." Both the statin-treated group and the usual care group had a significant decrease in cholesterol levels. There was no difference in major cardiovascular disease outcomes, largely because the difference in cholesterol reduction between the two groups was small. However, it is important to note that the ALLHAT lipid results are consistent with strong evidence from other trials that statin therapy reduces heart attacks and deaths from heart disease. Likewise, the ALLHAT results are consistent with existing recommendations for the prevention and treatment of high blood cholesterol.
ALLHAT has provided important evidence about how to treat two major risk factors for heart disease-this country's #1 killer. Widespread dissemination of the ALLHAT results is key to ensuring that patients, physicians, and the health care delivery system benefit from its findings. The NHLBI, the ALLHAT investigators--which include more than 600 practicing physicians--and other groups are taking the lead in disseminating the results of the trial. Tools to help in this effort include quick reference summaries, articles, case studies, and other products which can be found on the NHLBI Web site.
The bottom line is that for patients, physicians, and insurers alike, the ALLHAT results are welcome news. For hypertension, the low-cost drug option works best. For high blood cholesterol, the current treatment recommendations remain unchanged. ALLHAT gives us reliable evidence that translates into better care and better health for millions of Americans.