What are the best first-line antihypertensives: answers and more questions from the ALLHAT study.

Overview

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is considered the largest trial of antihypertensive therapy conducted to date. It compared the cardiovascular effects of three more recently developed classes of antihypertensive agents to those of a diuretic in an attempt to identify which of these drugs should be the recommended first-line agent for the treatment of hypertension. In this report the paper is discussed with the significance and the clinical implications of the results contrasted with existing evidence in hypertension research. Additionally, further questions raised by the ALLHAT study are explored with ongoing studies, and future directions with which to answer these emerging new questions are outlined.