Davis BR et al. for the ALLHAT Collaborative Research Group (2008) Heart failure with preserved and reduced left ventricular ejection fraction in the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial. Circulation 118: 2259–2267

Davis et al. have published findings from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) demonstrating that chlorthalidone is superior to both amlodipine and doxazosin for the prevention of new-onset heart failure (HF) with preserved (>50%) and reduced (<50%) ejection fraction in patients with hypertension.

In this randomized, double-blind, multicenter trial, ejection fraction data were available for 910 of 1,367 patients hospitalized with HF. All participants were aged 55 years or older, had hypertension and one additional cardiovascular risk factor, and were randomly assigned to treatment with chlorthalidone, amlodipine, lisinopril, or doxazosin. Hospitalization for HF occurred with preserved and reduced ejection fraction in 44% and 56% of patients, respectively. HF-related mortality was higher among patients with reduced ejection fraction compared with those who had preserved ejection fraction (41.9% versus 29.2%, P <0.001). Chlorthalidone was associated with a 30–48% reduction in the risk of HF with preserved ejection fraction compared with the other study drugs. The risk of HF with reduced ejection fraction was lower among patients who received chlorthalidone than in those on amlodipine (by 22%) or doxazosin (by 36%), but no difference in risk reduction was found between the chlorthalidone and lisinopril arms. The authors postulate that a combination of chlorthalidone and lisinopril would be most effective for the prevention of HF in older patients with hypertension.