Coronary heart disease prevention As the primary goal in contemporary trials in the treatment of hypertension.

The prevention of coronary heart disease remains one of the greatest challenges for antihypertensive therapy. Previous trials have identified a shortfall in the protection of hypertensive patients against coronary heart disease compared with that predicted from observational studies. The present question is whether newer classes of drugs or drug combinations (calcium channel blockers, angiotensin converting enzyme inhibitors) can redress the shortfall compared with older agents (diuretics, beta-blockers). However, to answer this question only two trials (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial [ALLHAT] and Anglo Scandinavian Cardiac Outcomes Trial [ASCOT]) are of sufficient size to be adequately powered to address this issue. ALLHAT and ASCOT have completed randomization of patients and will report on morbidity and mortality within 3 to 4 years.