A new era in hypertension research: discussing the findings of ALLHAT

The key question in hypertension research today is, "Does it matter how elevated blood pressure is lowered?" The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) initiated in 1994 serves as a model for comparative trials. Its strengths include its independent sponsorship, scope and design. The alpha-blocker arm was stopped early; doxazosin was shown to be clearly inferior to low-dose chlorthalidone not only in preventing heart failure, but also stroke, in spite of similar blood pressure reduction. The findings have major public health implications as pointed out by Krakoff in this journal. Other commentaries by Gavras and Gavras and Hooper discuss possible mechanisms behind the excess of cardiovascular events in doxazosin-treated patients.