1. Post-Heart Failure Mortality
ALLHAT
Post-Heart Failure Mortality

2. ALLHAT
Objective
To examine mortality rates after initiation of hospitalization or outpatient treatment for heart failure

3. Cumulative Mortality Following Hospitalized HF
ALLHAT .7
Chlorthalidone .6
Amlodipine
Lisinopril .5 .4
Cumulative mortality rate .3 .2 .1 1 2 3 4 5 6
Years to Death

4. Cumulative Mortality Following Non-Hospitalized Treated HF
ALLHAT
Cumulative Mortality Following Non-Hospitalized Treated HF .1 .2 .3 .4 .5 .6 .7 1 2 3 4 5 6
Chlorthalidone
Amlodipine
Lisinopril
Cumulative mortality rate
Years to Death

5. Cumulative Mortality Following Hospitalized and Non-Hospitalized HF
ALLHAT .7
Chlorthalidone .6
Amlodipine
Lisinopril .5 .4
Cumulative mortality rate .3 .2 .1 1 2 3 4 5 6
Years to Death

6. Cumulative Mortality Following Hospitalized HF
ALLHAT
Cumulative Mortality Following Hospitalized HF
Cumulative mortality rate
Chlorthalidone .6
Doxazosin .5 .4 .3 .2 .1 1 2 3 4
Years hospitalized HF to death

7. Cumulative Mortality Following Non-Hospitalized Treated HF
ALLHAT
Cumulative Mortality Following Non-Hospitalized Treated HF 1 2 3 4 .1 .2 .3 .4 .5 .6
Doxazosin
Chlorthalidone
Cumulative mortality rate
Years treated HF to death

8. Cumulative Mortality Following Hospitalized and Non-Hospitalized HF
ALLHAT
Cumulative Mortality Following Hospitalized and Non-Hospitalized HF
Chlorthalidone .6
Doxazosin
Cumulative mortality rate .5 .4 .3 .2 .1 1 2 3 4
Years hospitalized or treated HF to death

9. ALLHAT All-Cause Mortality .7 .6 .5 From 1st HF Event .4
Cumulative Mortality Rate .3
From Baseline .2
The three core messages for the ALLHAT antihypertensive trial are:
Diuretics should be the drug of choice for first step therapy of hypertension
For the patient who cannot take a diuretic (which should be an unusual circumstance), CCB’s and ACEI’s may be considered.
Most hypertensive patients require more than one drug. Diuretics should generally be part of the antihypertensive regimen. Lifestyle advice should also be provided. .1 1 2 3 4 5 6
Years to Death

10. ALLHAT Conclusions Post-HF mortality is high
Mortality rates after first hospitalization with HF are on the order of about 10% per year, reaching 50% at 5 years
Mortality after initial out-patient treatment is only slightly less
Subsequent reports will compare randomized groups in more detail