Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent XXXX trial (ALLHAT).

@entity1 @entity101 @entity6 @entity301 @entity3593 @entity3591 @entity299 @entity9804
CONTEXT: Blood pressure control (<140/90 mm Hg) rates for @entity101 fall far short of the US national goal of 50% or more. Achievable control rates in varied practice settings and geographic regions and factors that predict improved blood pressure control are not well identified. OBJECTIVE: To determine the success and predictors of blood pressure control in a large @entity101 trial involving a multiethnic population in diverse practice settings. DESIGN: The Antihypertensive and Lipid-Lowering Treatment to Prevent @entity299 Trial is a randomized, double-blind, active-controlled clinical trial with a mean follow-up of 4.9 years. @entity1 enrollment began in February 1994 and follow-up was completed in March 2002. SETTING: A total of 623 centers in the United States, Canada, and the Caribbean. @entity1 : A total of 33,357 @entity1 (aged > or =55 years) with @entity101 and at least one other @entity301 risk factor. INTERVENTIONS: @entity1 were randomly assigned to receive (double-blind) @entity9804 , 12.5-25 mg/d (n=15,255), @entity3591 2.5-10 mg/d (n=9048), or @entity3593 10-40 mg/d (n=9054) after other medication was discontinued. Doses were increased within these ranges and additional drugs from other classes were added as needed to achieve blood pressure control (<140/90 mm Hg). MAIN OUTCOME MEASURES: The outcome measures for this report are systolic and diastolic blood pressure, the proportion of @entity1 achieving blood pressure control (<140/90 mm Hg), and the number of drugs required to achieve control in all three groups combined. RESULTS: Mean age was 67 years, 47% were @entity1 , 35% black, 36% @entity6 ; 90% were on antihypertensive drug treatment at entry. At the first of two pre-randomization visits, blood pressure was <140/90 mm Hg in only 27.4% of @entity1 . After 5 years of follow-up, the percent controlled improved to 66%. Systolic blood pressure was <140 mm Hg in 67% of @entity1 , diastolic blood pressure was <90 mm Hg in 92%, the mean number of drugs prescribed was 2.0+/-1.0, and the percent on > or =2 drugs was 63%. Blood pressure control varied by geographic regions, practice settings, and demographic and clinical characteristics of @entity1 . CONCLUSIONS: These data demonstrate that blood pressure may be controlled in two thirds of a multiethnic @entity101 population in diverse practice settings. Systolic blood pressure is more difficult to control than diastolic blood pressure, and at least two antihypertensive medications are required for most @entity1 to achieve blood pressure control. It is likely that the majority of @entity1 with @entity101 could achieve a blood pressure <140/90 mm Hg with the antihypertensive medications available today.
