Amlodipine or lisinopril was not better than chlorthalidone for reducing CVD risk in hypertensive black or nonblack patients.

نویسندگان

  • Meera Jain
  • Mark Rosenberg
چکیده

In black or nonblack patients with hyperten-sion, is amlodipine or lisinopril better than chlorthalidone for reducing cardiovascular disease (CVD)? Design: Randomized controlled trial (Anti-hypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial [ALLHAT]). Patients: 33 357 black and nonblack patients ≥ 55 years of age (mean age 67 y, 35% black, 53% men overall, 54% women among blacks) who had untreated or treated hyper-tension with ≥ 1 additional risk factor for coronary heart disease (CHD), including left ventricular (LV) hypertrophy, type 2 diabetes mellitus, current smoker, high-density lipo-protein cholesterol level < 0.9 mmol/L (35 mg/dL), and myocardial infarction (MI) or stroke in the previous 6 months. Patients with treated symptomatic heart failure (HF) or LV ejection fraction < 35% were excluded. Intervention: Chlorthalidone, 12.5 to 25 mg/d (n = 15 255); amlodipine, 2.5 to 10 mg/d (n = 9048); or lisinopril, 10 to 40 mg/d (n = 9054). Outcomes: Composite endpoint of fatal CHD and nonfatal MI. Secondary outcomes included all-cause mortality, fatal and non-fatal stroke, combined CHD, and combined CVD. Patient follow-up: 97% (intention-to-treat analysis). Overall, fewer blacks than nonblacks had the composite endpoint (9.7% vs 12.3%), combined CHD (15.9% vs 22.5%), and combined CVD (28.4% vs 33.7%) (P for all interactions < 0.001). Blacks had higher rates of stroke (6.5% vs 5.3%, P < 0.001), end-stage renal disease (2.6% vs 1.5%, P < 0.001), and overall mortality (17.7% vs 16.8%, P = 0.003) than nonblacks. The 3 treatment groups did not differ for the composite endpoint in either racial subgroup (Table). In blacks or nonblacks, no difference was found between amlodipine and chlorthalidone for any secondary outcomes except for HF (relative risk [RR] for In black or nonblack patients with hyperten-sion, amlodipine or lisinopril was not better than chlorthalidone for reducing cardiovascu-lar disease. Chlorthalidone was associated with a lower risk for heart failure than amlodipine or linisopril in either racial subgroup. ©ACP 63 C o m m e n t a r y In this planned substudy of the ALLHAT trial (1), Wright and colleagues examined whether CVD outcomes differed between black and nonblack patients who were started on 1 of 3 different classes of antihypertensive agents. Confirming the main trial's results, initial treatment with either amlodipine or lisinopril was not found to be superior to chlorthalidone in either racial group. In blacks, blood pressure (BP) was lowered by all 3 drugs, although less so by lisinopril, as …

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منابع مشابه

Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril.

CONTEXT Few cardiovascular outcome data are available for blacks with hypertension treated with angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers (CCBs). OBJECTIVE To determine whether an ACE inhibitor or CCB is superior to a thiazide-type diuretic in reducing cardiovascular disease (CVD) incidence in racial subgroups. DESIGN, SETTING, AND PARTICIPANTS Prespecified ...

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Heart failure with preserved and reduced left ventricular ejection fraction in the antihypertensive and lipid-lowering treatment to prevent heart attack trial.

BACKGROUND Heart failure (HF) developing in hypertensive patients may occur with preserved or reduced left ventricular ejection fraction (PEF [>or=50%] or REF [<50%]). In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), 42 418 high-risk hypertensive patients were randomized to chlorthalidone, amlodipine, lisinopril, or doxazosin, providing an opportunity...

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Metabolic and clinical outcomes in nondiabetic individuals with the metabolic syndrome assigned to chlorthalidone, amlodipine, or lisinopril as initial treatment for hypertension: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

OBJECTIVE Optimal initial antihypertensive drug therapy in people with the metabolic syndrome is unknown. RESEARCH DESIGN AND METHODS We conducted a subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to compare metabolic, cardiovascular, and renal outcomes in individuals assigned to initial hypertension treatment with a thiazide-like ...

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Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

BACKGROUND This study was performed to determine whether, in high-risk hypertensive patients with a reduced glomerular filtration rate (GFR), treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of renal disease outcomes compared with treatment with a diuretic. METHODS We conducted post hoc analyses of the Antihypertensive and Lipid-Lower...

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عنوان ژورنال:
  • ACP journal club

دوره 143 3  شماره 

صفحات  -

تاریخ انتشار 2005