SHEP

systolic hyperetension in the elderly program

1991

studied chlorthalidone vs. placebo

showed reduction in incidence of

CV events and stroke

1993

Drugs:  -placebo -HCTZ -atenolol -clonidine

-captopril -prazosin -diltiazem

-showed age and race differences in drug response

-HCTZ was best in older blacks, while captopril was the worst.

-showed that blacks responded better to sodium load treatment (HCTZ) while younger whites responed better to renin mediated treatment

HOPE

hypertension outcomes prevention evaluation

2000

- ramipril vs. placebo

ACE-i's reduce rates of death, MI, and stroke

FACET and ABCD

Compare DHPCCB to ACE-i in patients with diabetes

ACE-i showed lower rates of coronary events and death -> showed the benefits of using ACE-i's in diabetic patients

ALLHAT

antihypertensive and lipid lowering treatment to prevent heart attack trial

2002

compared chlorthalidone, amlodipine, and lisinopril

-showed that thiazide diuretics are superior to ACE or CCB in preventing coronary outcomes and should be considered first line therapy for HTN

-doxazosin vs. chlorthalidone arm was stopped -> doxazosin showed 25% more CV events and 2x more likely to be hospitalized for CHF

ONTARGET

ongoing telmisartan alone and in combination with ramipril global endpoint trial

2008

established that ARB's had similar efficacy to

ACE-i's in preventing morbitity and mortality

-showed a better tolerance of ARBs to ACE-i's

-stopped concurrent use of ACE-i's and ARB's due to increased incidence of renal failure and initiation dialysis