Doxazosin

The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major cardiovascular events in hypertensive patients randomized to doxazosin vs. chlorthalidone: The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 2000,283(15): 1967-75.

Lasagna L: Diuretics vs. alpha-blockers for treatment of hypertension: Lessons from ALLHAT. JAMA 2000;283(15):2013-14.

In this trial, 24,335 patients age 55 and older with hypertension and at least one other coronary heart disease (CHD) risk factor were enrolled at 625 centers in a randomized, doubleblind, active-controlled study of four types of antihypertensive drugs. In January 2000, the doxazosin treatment arm was halted when an interim analysis showed chlorthalidone significantly reduced the risk of combined cardiovascular events, particularly heart failure. After a median follow-up of 3.3 years, there was no difference in risk between the groups in fatal CHD, nonfatal myocardial infarction, or total mortality. Patients in the doxazosin arm had a higher risk of stroke (relative risk [RR] 1.19) and combined cardiovascular disease (RR 1.25). Risk for heart failure was doubled. This study cannot assess the relative risks and benefits of doxazosin in patients with symptoms of prostatism and has no bearing on the use of doxazosin in combination with other antihypertensive drugs. As a first-line antihypertensive drug, chlorthalidone appears to be superior to doxazosin in this diverse group of older hypertensive patients with other CHD risk factors. Because this was not a placebocontrolled trial, the study did not assess if doxazosin is superior to placebo.

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