FYI from the NHLBI Index

September 2009: Vol. 10, Issue 2
In the News

News from Capitol Hill

Science Advance from the NHLBI

• ALLHAT Provides New Information on Preventing Heart Failure in Patients with Hypertension

Smoking Prevention and Control

New NIH Director Appointed

Following unanimous conformation by the Senate, on August 11, 2009, Dr. Francis Collins was sworn in as the 16th director of the National Institutes of Health. Dr. Collins, a physician-geneticist noted for his landmark discoveries of disease genes and his leadership of the Human Genome Project, served as director of NIH’s National Human Genome Research Institute from 1993-2008. In President Obama’s nomination announcement, the President noted that “The National Institutes of Health stands as a model when it comes to science and research. My administration is committed to promoting scientific integrity, and pioneering scientific research and I am confident that Dr. Francis Collins will lead the NIH to achieve these goals. Dr. Collins is one of the top scientists in the world and his groundbreaking work has changed the very ways we consider our health and examine diseases.”

Recent Advance from the NHLBI

ALLHAT Provides New Information on Preventing Heart Failure in Patients with Hypertension

Hypertension (high blood pressure) is a leading cause of heart failure, a serious condition with debilitating symptoms (including shortness of breath and fatigue) that causes about 300,000 deaths in the United States each year. In 2002, the NHLBI-supported Antihypertensive and Lipid-Lowering to Prevent Heart Attack Trial (ALLHAT)—a randomized, practice-based trial involving over 42,000 high-risk individuals with hypertension—reported that traditional diuretics were superior in treating high blood pressure and preventing cardiovascular events (including heart failure) to several newer, more expensive classes of medications (calcium-channel blockers, alpha-adrenergic blockers, and angiotensin-converting enzyme [ACE] inhibitors) and provided strong evidence that diuretics should be the initial treatment of choice for lowering high blood pressure in most patients. ALLHAT also found that most patients need more than one drug to control their blood pressure adequately.

Recently, ALLHAT investigators re-examined the incidence of heart failure in ALLHAT participants. The investigators carefully studied hospital records of ALLHAT participants to identify patients with heart failure and the type of heart failure they had. Heart failure has two main types, both of which occur in hypertensive patients and cause substantial death and disability. One type, heart failure with reduced ejection fraction, usually occurs because the heart cannot contract normally and therefore cannot pump forcefully. The other, heart failure with preserved ejection fraction, develops because the heart muscle stiffens, impeding the heart’s ability to fill normally with blood; blood then backs up in the lungs and veins.

The recent analysis showed that initiating treatment with diuretics significantly reduced the overall risk of heart failure requiring hospitalization, and also reduced the risk of heart failure with preserved ejection fraction, compared with initial treatment with any of the three other medications tested. In addition, initial treatment with diuretics reduced the risk of heart failure with reduced ejection fraction compared with calcium-channel blockers and alpha-adrenergic blockers, and had an effect similar to ACE-inhibitors in reducing risk of this type of heart failure.

Considering these results along with data from many heart failure trials, the investigators concluded that treatment with a combination of diuretics and ACE-inhibitors is likely to be especially effective in preventing heart failure in high-cardiovascular-risk patients with hypertension. Given estimates that nearly 1 in 3 adults in the United States has high blood pressure and the large proportion of people with high blood pressure who eventually develop heart failure, results such as these that can help fine-tune treatment guidelines hold promise for preventing development of many cases of heart failure.

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