Quote from Lenin:

But the drugs chosen for testing were chosen in the early 90's...they were stuck with results on a generic that was proprietary when the test began.
Thus the cost argument was very valid. You can't switch drugs in the middle of a decade long trial.

This isn't even my argument. The problem I have is that ALLHAT claims that usage of diuretics is a huge cost savings. And, this was all published in 2003.

ALLHAT is one of the most flawed studies ever created. It was designed to prove that diuretics are superior. In spite of all this advantage, all it could claim was that they are equal. So, then, they latched on to the cost argument.

Another thing I find interesting is the slides (BTW, the main ALLHAT website is at http://allhat.sph.uth.tmc.edu ) on why a Beta Blocker wasn't tested for first-line therapy.
[QUOTE]Feasibility considerations allow only 3-4 arms--traditional drug(s), ACEI, CCB, +1?Then, why did you mess around with an alpha-blocker (doxazosin)? Beta-blockers were and are used far more frequently than alpha-blockers.
[QUOTE]Pooled results of 3 older diuretic vs. beta-blocker trials showed no CVD differences.Oh, that's why. A diuretic is equal to a beta-blocker :rolleyes:. Then, why not save the cost of even having this ALLHAT study and pool all the other studies. It doesn't matter what the results are. You've already determined what they are going to be before even having the study. Admit it, the real reason you didn't include a beta-blocker is that it is cheap. And, you wouldn't be able to use your cost argument. So, let's pick an expensive alpha-blocker to compete with our cheap diuretic.

Also, ALLHAT was designed to prove that the entire world should be put on statins. Again, the results didn't prove this either. And, this is even more interesting. When the results don't match what you are trying to prove, let's just explain it away. From the ALLHAT FAQ:
[QUOTE]A pertinent fact to note is the non-blinded nature of the ALLHAT lipid-lowering component. Among those usual care participants who were not prescribed statins, the non-blinded nature of the study may have led to increased use of other, non-statin or non-pharmacologic means to reduce lipid levels. This feature of the study design may have further decreased the differences between the pravastatin and usual care groups.

The findings of ALLHAT do not challenge the previous data regarding the efficacy of statins. The absence of a reduction in all-cause mortality and the small reductions in coronary heart disease and stroke events fall within the range of results that would be predicted for a 9% differential in total cholesterol. The results of ALLHAT do not suggest that statin treatment should be discontinued or avoided. The ALLHAT results support previous findings that statins are beneficial in cholesterol reduction, and, accordingly, event reduction.Unbelievable. They draw up whatever conclusion they set out to prove regardless of the actual result obtained.

BTW, no where in the ALLHAT FAQ does it say anything about the increased diabetes risk associated with diuretics. Oh yeah, that's right. That's not a CVD issue. I guess that falls under "Quality of Life" issues. BTW, where are the quality of life results from ALLHAT?

I guess you as patient shouldn't care about quality of life either. A quote from the ALLHAT FAQ:
[QUOTE]I recently discovered I have high blood pressure. My doctor wants to put me on a diuretic. My husband’s doctor has had him on an ACE-inhibitor for years and believes it is the best medication for high blood pressure. Who should I listen to?

Listen to your doctor because he/she knows your situation best. Your doctor will tell you that the results of ALLHAT address the issue of first-line treatment very well. ALLHAT compared cardiovascular (heart) events (like heart attack) between patients taking a calcium channel blocker or ACE inhibitor to those taking a diuretic. Here’s what they found: Neither the ACE inhibitor nor the calcium channel blocker was better than the diuretic in preventing major heart attacks or in increasing the length of time that someone survived.
...Again, no considerations given for quality of life. I'm surprised it doesn't tell the wife to nag her husband to have meds switched to a diuretic. I suppose the wife might not be able to enjoy her husband as frequently if he did this. Or, maybe he should consider a beta-blocker. After all, according to the study designers, they are equal.

Pal