An estimated 50 million people in the U.S. have high blood pressure (systolic blood pressure [SBP] >140mmHg and/or diastolic BP [DBP] >90mmHg), or are taking antihypertensive medications. All factors considered and remaining constant, the incremental cost of treating 25 million patients with a drug costing $100/patient-year of therapy compared to one costing $500/patient-year of therapy is $10 billion. Hypertension is considered more frequent among African Americans than Caucasians, and its sequelae are also seen more frequently in African Americans. Thus, the ALLHAT trial, a nationwide, practice-based, randomized clinical trial of antihypertensive pharmacological treatments and cholesterol-lowering to prevent heart attacks in a specific subset of 40,000 high-risk hypertensive patients, is to include at least 55% African Americans. The purpose of the antihypertensive treatment arm is to determine the combined incidence of fatal coronary heart disease and non-fatal myocardial infarction between diuretic treatment and three alternative (and more expensive) antihypertensive pharmacological treatments. The purpose of the lipid-lowering treatment arm is to determine if lowering serum cholesterol in moderately hypercholesterolemic men and women aged 60 years and older, with a specific 3-hydroxymethylglutaryl coenzyme A reductase inhibitor, will reduce all-cause mortality as compared to a control group receiving """"""""usual care."""""""" Secondary objectives of both trial components are to compare the effects of their respective treatment regimens on cardiovascular mortality, major morbidity, health costs, and health-related quality of life.
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