In Reply: Dr Chikamori suggests that the high
prevalence of atherosclerotic cardiovascular disease and baseline left ventricular
(LV) dysfunction may be responsible for the difference in heart failure between
the chlorthalidone and both the lisinopril and amlodipine arms of ALLHAT.
The prevalence of atherosclerotic disease (52%) observed in ALLHAT, although
higher than in the trials he indicates, was less than that in the The Heart
Outcomes Prevention Evaluation Study Investigators (HOPE) trial (80%).1 Assessment of LV function was not required at baseline
in ALLHAT. However, hypertensive patients with a history of heart failure
or measured LV ejection fraction of less than 35% were excluded from the trial.
Long-term Cardiovascular Consequences of Diuretics vs Calcium Channel
Blockers vs Angiotensin-Converting Enzyme Inhibitors—Reply. JAMA. 2003;289(16):2066. doi:10.1001/jama.289.16.2069