Comments on ALLHAT and doxazosin

This commentary has two purposes: to summarize the rationale, design and initial results of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial; and to provide a history of the response to ALLHAT that led to a civil action and a Citizens Petition that was the basis for a public hearing by the US Food and Drug Administration, in May 2001. The author concludes that the results of ALLHAT should be widely disseminated. All clinicians must be warned that initial therapy with doxazosin (and possibly other alpha₁ blockers) is definitely inferior to low dose diuretic treatment for patients at high risk for cardiovascular disease, such as those enrolled in ALLHAT.