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April 23/30, 2003

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

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.