Choice of treatment: outcomes and treatment goals

Rather, physicians were limited to ?-blockers, reserpine, and clonidine; imperfect add-on choices for at least some of the treatments, where a diuretic would be far more usual and probably preferable. [...]although there is a well-established, essentially additive effect on blood pressure produced by angiotensin-converting enzyme inhibitors (ACEIs) and diuretics, although all outcome studies of ACEIs in heart failure used those drugs in addition to diuretics, and although that combination (unlike ACEIs alone) has a similar effect on blood pressure in both black and nonblack patients, such a combination could not, for the most part, be used in ALLHAT. [...]despite the constrained follow-on therapy, there was no difference between chlorthalidone, amlodipine, and lisinopril for the primary study outcome (total coronary heart disease or nonfatal myocardial infarction), all-cause mortality, or combined coronary heart disease.