Once Again Not So Easy to Prevent
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See Article by Dewland et al
The ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a multicenter, double-blinded, parallel-group, randomized controlled trial examining the effect of 4 different antihypertensive agents on the incidence of cardiovascular events.1 The study enrolled hypertensive patients at least 55 years old with at least 1 additional risk factor for coronary artery disease. When comparing primary outcomes of combined fatal coronary artery disease or nonfatal myocardial infarction, neither lisinopril nor amlodipine use led to a significant reduction compared with chlorthalidone. Chlorthalidone did result in a significant reduction in combined coronary artery disease, stroke, congestive heart failure, and peripheral arterial disease and treated angina without hospitalization. In addition to antihypertensive randomization, patients with elevated low-density lipoprotein cholesterol were randomized to receive pravastatin or usual care.
Atrial fibrillation (AF) is the most commonly encountered arrhythmia and is associated with an increased risk of mortality and stroke.2,3 Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and statins have been suggested as a potential upstream pharmacological agents for the primary prevention of AF.4 The data available suggest that ACEI or ARB therapy can lead to a reduction in the incidence of new-onset AF in patients with reduced left ventricular systolic function …