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#45 De: galcala.vwaisman@interredes.com.ar (Gustavo Alcala)
Enviado: Domingo, 02 de Abril de 2000 11:08 p.m.
Asunto: Otra vez los dureticos.Estudio ALLHAT
Durante el PCVC nos hemos referido al tema de diureticos e HTA, hace poco tiempo el Instituto del Corazon, Pulmon y la Sangre (NHLBI) interrumpio prematuramente una parte del estudio ALLHAT debido a que el bloqueante alfa adrenergico doxazosina (metabolicamente "apropiado" ya que baja el colesterol serico) es menos efectivo que la clortalidona!
Los pacientes que usaban doxazosina tuvieron 25% mas eventos cardiovasculares y el doble de probabilidad de ser hospitalizados por
insuficiencia cardiaca comparados con los tratados con clortalidona, que tiene un costo considerablemente menor. 
Por ahora los diureticos deberian ser las drogas preferidas para tratar la hipertension, excepto en casos especiales, particularmente en nuestros
paises latinoamericanos.
•Davis B, Furberg CD. Antihypertensive and lipid-lowering treatment to prevent heart attack (ALLHAT). Late-breaking clinical trial. Presented at the American College of Cardiology 49th Scientific Session. March 12-15, 2000. Anaheim, Calif.
Gustavo Alcala

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#46 De: Edgardo Schapachnik < edgardo@schapachnik.com.ar >
Enviado: Miércoles, 05 de Abril de 2000 10:01 a.m.
Asunto: Sesion de Chat sobre Epidemiologia de los Factores de Riesgo
Queridos colegas:
Recuerdo a ustedes que el proximo viernes 14 de abril realizaremos una sesion de Chat academico sobre el tema Epidemiologia de los Factores de Riesgo, en el marco del Foro de Educacion Continua del Primer Congreso Virtual de Cardiologia..
Respondera preguntas el Dr. Mario Ciruzzi, medico cardiologo y epidemiologo del Hospital Pirovano de Buenos Aires.
Aquellos de ustedes que esten interesados en participar de esta sesion, asi como de las futuras que estan programadas, deberan requerir
informacion acerca del horario, servidor de chat y canal donde se llevara a cabo el evento, enviando un mail a
chat-pcvc@pcvc.sminter.com.ar
Recibiran ademas instrucciones sobre las reglas de netiquette que deberan respetarse en sesiones de esta naturaleza.
Quienes deseen suscribirse al FORO CHAT-PCVC y recibir informacion sobre las actividades de chat programadas para el anio 2000, asi como las sesiones de entrenamiento:
Enviar un mail a majordomo@pcvc.sminter.com.ar
con el siguiente comando:
subscribe chat-pcvc
Cordialmente
Edgardo

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#47 De: Edgardo Schapachnik < edgardo@schapachnik.com.ar >
Enviado: Miércoles, 05 de Abril de 2000 03:31 p.m.
Asunto: Doxazosin y clortalidona
Queridos amigos:
En relacion al comentario que efectuara el dia 2 de abril, Gustavo Alcala referente al estudio ALLHAT, que comparo los resultados de usar Doxazosin y Clortalidona en pacienteds hipertensos, transcribo a continuacion el abstract del respectivo trabajo, publicado en el numero de hoy de la revista JAMA.
Pueden obtener el articulo completo en:
http://jama.ama-assn.org/issues/v283n15/full/joc00401.html
Espero lo disfruten y comenten en el Foro.
Un abrazo
Edgardo
===========================================================================
Vol. 283 No. 15, April 19, 2000
Original Contribution
JAMA-EXPRESS  
               Major Cardiovascular Events in
               Hypertensive Patients Randomized to
               Doxazosin vs Chlorthalidone 
               The Antihypertensive and Lipid-Lowering
               Treatment to Prevent Heart Attack Trial
               (ALLHAT)                 
               The ALLHAT Officers and Coordinators for the ALLHAT
               Collaborative Research Group
Context 
Hypertension is associated with a significantly increased risk of morbidity and mortality. Only diuretics and -blockers have been shown to reduce this risk in long-term clinical trials.
Whether newer antihypertensive agents reduce the incidence of cardiovascular disease (CVD) is unknown.
Objective 
To compare the effect of doxazosin, an a-blocker, with chlorthalidone, a diuretic, on incidence of CVD in patients with hypertension as part of a
study of 4 types of antihypertensive drugs: chlorthalidone, doxazosin, amlodipine, and lisinopril.
Design 
Randomized, double-blind, active-controlled clinical trial, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial, initiated in February 1994. In January 2000, after an interim analysis, an independent data review committee recommended discontinuing the doxazosin treatment arm based on comparisons with chlorthalidone. Therefore, outcomes data presented herein reflect follow-up through December 1999.
Setting 
A total of 625 centers in the United States and Canada.
Participants 
A total of 24,335 patients (aged 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor who received either
doxazosin or chlorthalidone.
Interventions 
Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n=15,268), or doxazosin, 2 to 8 mg/d (n=9067), for a planned
follow-up of 4 to 8 years.
Main Outcome Measures 
The primary outcome measure was fatal CHD or nonfatal myocardial infarction (MI), analyzed by intent to treat; secondary outcome measures included all-cause mortality, stroke, and combined CVD (CHD death, nonfatal MI, stroke, angina, coronary revascularization, congestive heart failure [CHF], and peripheral arterial disease); compared by the chlorthalidone group vs the doxazosin group.
Results 
Median follow-up was 3.3 years. A total of 365 patients in the doxazosin group and 608 in the chlorthalidone group had fatal CHD or nonfatal MI, with no difference in risk between the groups (relative risk [RR], 1.03; 95% confidence interval [CI], 0.90-1.17; P=.71). Total mortality did not differ between the doxazosin and chlorthalidone arms (4-year rates, 9.62% and 9.08%, respectively; RR, 1.03; 95% CI, 0.90-1.15; P=.56.) The doxazosin arm, compared with the chlorthalidone arm, had a higher risk of stroke (RR, 1.19; 95% CI, 1.01-1.40; P=.04) and combined CVD (4-year rates, 25.45% vs 21.76%; RR, 1.25; 95% CI, 1.17-1.33; P<.001). Considered separately, CHF risk was doubled (4-year rates, 8.13% vs 4.45%; RR, 2.04; 95% CI, 1.79-2.32; P<.001); RRs for angina, coronary revascularization, and peripheral arterial disease were 1.16 (P<.001), 1.15 (P=.05), and
.07 (P=.50), respectively.
Conclusion 
Our data indicate that compared with doxazosin, chlorthalidone yields essentially equal risk of CHD death/nonfatal MI but significantly reduces
the risk of combined CVD events, particularly CHF, in high-risk hypertensive patients.
JAMA. 2000;283:1967-1975

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