The recently reported Antihypertensive and Lipid-Low-ering Treatment to Prevent Heart Attack Trial

The recent Antihypertensive and Lipid-Lowering Treatment to Pre-vent Heart Attack Trial (ALLHAT) showed that the primary end point, coronary heart disease, was identical in the chlorthalidone, lisinopril, and amlodipine groups. Yet the major conclusion of this trial was that thiazide diuretics are superior in preventing 1 or more major forms of cardiovascular disease and should be pre-ferred for first-line antihypertensive therapy. This conclusion was based solely on an analysis of secondary end points and cost. As evidenced by the dictum to “use thiazides for most patients wit