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Clinical Trial
. 2004 Mar;6(3):116-25.
doi: 10.1111/j.1524-6175.2004.03216.x.

Cardiovascular outcomes using doxazosin vs. chlorthalidone for the treatment of hypertension in older adults with and without glucose disorders: a report from the ALLHAT study

Joshua I Barzilay  1 , Barry R Davis, Judy Bettencourt, Karen L Margolis, David C Goff Jr, Henry Black, Gabriel Habib, Allan Ellsworth, Rex W Force, Thomas Wiegmann, Jerry O Ciocon, Jan N Basile; ALLHAT Collaborative Research Group
Affiliations
Clinical Trial

Cardiovascular outcomes using doxazosin vs. chlorthalidone for the treatment of hypertension in older adults with and without glucose disorders: a report from the ALLHAT study

Joshua I Barzilay et al. J Clin Hypertens (Greenwich). 2004 Mar.

Abstract

Insulin resistance underlies most glucose disorders in adults and is associated with an increased risk of cardiovascular disease. Alpha blockers decrease insulin resistance, whereas diuretics increase insulin resistance. The authors studied the effects of these two classes of hypertension medications (doxazosin, an a blocker, and chlorthalidone, a diuretic) on cardiovascular disease outcomes in adults aged >55 years with hypertension and glucose disorders who were participants in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (8749 had known diabetes mellitus and 1690 had a newly diagnosed glucose disorder [fasting glucose >/=110 mg/dL]). There was no difference in either group between the chlorthalidone- and doxazosin-based treatments with regard to fatal or nonfatal myocardial infarction or all-cause mortality. There was, however, a difference for combined cardiovascular disease (myocardial infarction, revascularization procedures, angina, stroke, heart failure, and peripheral arterial disease) in favor of the diuretic. This difference was due primarily to an increased heart failure risk in those treated with doxazosin (relative risk, 1.85; 95% confidence interval, 1.56-2.19) in the known diabetes mellitus group and a relative risk of 1.63 (95% confidence interval, 1.05-2.55) in those with a newly diagnosed glucose disorder despite lower glucose levels on follow-up in those treated with a blockers. The authors conclude that treatment of hypertension with doxazosin in adults with glucose disorders incurs the same risk of coronary heart disease as treatment with chlorthalidone; however, treatment with doxazosin increases the risk of combined cardiovascular disease and heart failure despite lower glucose levels.

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Figures

Figure 1
Figure 1
Flow chart of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial
Figure 2
Figure 2
Cumulative incidence of heart failure in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial by type of antihypertensive treatment in those with A) diabetes mellitus (DB), B) new glucose disorder (NGD), and C) no glucose abnormality. CHF=congestive heart failure
See this image and copyright information in PMC

References

    1. Giordano M, Matsuda M, Sanders L, et al. Effects of angiotensin‐converting enzyme inhibitors, Ca2+ channel antagonists, and α‐adrenergic blockers on glucose and lipid metabolism in NIDDM patients with hypertension. Diabetes. 1995;44:665–671. - PubMed
    1. Glanz M, Garber AJ, Mancia G, et al. Meta‐analysis of studies using selective alpha 1‐blockers in patients with hypertension and type 2 diabetes. Int J Clin Pract. 2001;55:694–701. - PubMed
    1. Julius S. Are different hemodynamic patterns of antihypertensive drugs clinically important? Eur J Clin Pharmacol. 1990;38:S125–S128. - PubMed
    1. Grimm RA Jr, Flack JM, Schoenberger JA, et al. Alpha‐blockade and thiazide treatment of hypertension. A double‐blind randomized trial comparing doxazosin and hydrochlorothiazide. Am J Hypertens. 1996;9:445–454. - PubMed
    1. Maheux P, Facchini F, Jeppesen J, et al. Changes in glucose, insulin, lipid, lipoprotein, and apoprotein concentrations and insulin action in doxazosin‐treated patients with hypertension. Comparison between nondiabetic individuals and patients with non‐insulin‐dependent diabetes mellitus. Am J Hypertens. 1994;7:416–424. - PubMed

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