Franz H. Messerli, MD
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Messerli F.; Impact of ALLHAT on the Role of Angiotensin-Converting Enzyme Inhibitors in the Primary Prevention of Heart Failure. Ann Intern Med. 2004;141:W-9. doi: 10.7326/0003-4819-141-1-200407060-00037-w2
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Published: Ann Intern Med. 2004;141(1):W-9.
Congestive heart failure was not a prespecified end point in ALLHAT. Therefore, the science pertaining to this outcome is even softer than that pertaining to the prespecified secondary end points. The excessive attention congestive heart failure received is inappropriate and may be related to the inherent bias of some of the ALLHAT investigators. We should also remember that no other clinical end point is as difficult to objectively diagnose. In INSIGHT (International Nifedipine once-daily Study—Intervention as a Goal in Hypertension Treatment), unlike in ALLHAT, all end points were verified systematically by an end point committee, and the diagnosis of congestive heart failure decreased by a stunning 57% with reclassification (1). In ALLHAT, all the physician-investigators had to do was mark a box, and only a small fraction of all end points were verified.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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