Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic

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dc.contributor.authorUNSPECIFIED
dc.date.accessioned2019-08-14T15:01:52Z
dc.date.available2019-08-14T15:01:52Z
dc.date.issued2002
dc.description.abstractContext: Antihypertensive therapy is well established to reduce hypertensionrelated morbidity and mortality, but the optimal first-step therapy is unknown. Objective: To determine whether treatment with a calcium channel blocker or an angiotensin-converting enzyme inhibitor lowers the incidence of coronary heart disease (CHD) or other cardiovascular disease (CVD) events vs treatment with a diuretic. Design: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, active-controlled clinical trial conducted from February 1994 through March 2002. Setting and Participants: A total of 33357 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from 623 North American centers. Interventions: Participants were randomly assigned to receive chlorthalidone, 12.5 to 25 mg/d (n=15255); amlodipine, 2.5 to 10 mg/d (n=9048); or lisinopril, 10 to 40 mg/d (n=9054) for planned follow-up of approximately 4 to 8 years. Main Outcome Measures: The primary outcome was combined fatal CHD or nonfatal myocardial infarction, analyzed by intent-to-treat. Secondary outcomes were allcause mortality, stroke, combined CHD (primary outcome, coronary revascularization, or angina with hospitalization), and combined CVD (combined CHD, stroke, treated angina without hospitalization, heart failure [HF], and peripheral arterial disease). Results: Mean follow-up was 4.9 years. The primary outcome occurred in 2956 participants, with no difference between treatments. Compared with chlorthalidone (6- year rate, 11.5%), the relative risks (RRs) were 0.98 (95% CI, 0.90-1.07) for amlodipine (6-year rate, 11.3%) and 0.99 (95% CI, 0.91-1.08) for lisinopril (6-year rate, 11.4%). Likewise, all-cause mortality did not differ between groups. Five-year systolic blood pressures were significantly higher in the amlodipine (0.8 mm Hg, P=.03) and lisinopril (2 mm Hg, P.001) groups compared with chlorthalidone, and 5-year diastolic blood pressure was significantly lower with amlodipine (0.8mmHg, P.001). For amlodipine vs chlorthalidone, secondary outcomes were similar except for a higher 6-year rate of HF with amlodipine (10.2% vs 7.7%; RR, 1.38; 95% CI, 1.25-1.52). For lisinopril vs chlorthalidone, lisinopril had higher 6-year rates of combined CVD (33.3% vs 30.9%; RR, 1.10; 95% CI, 1.05-1.16); stroke (6.3% vs 5.6%; RR, 1.15; 95% CI, 1.02-1.30); and HF (8.7% vs 7.7%; RR, 1.19; 95% CI, 1.07-1.31). Conclusion: Thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and are less expensive. They should be preferred for first-step antihypertensive therapy.
dc.identifierhttps://doi.org/10.13016/ijiu-ejbp
dc.identifier.citationThe ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2002) Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic. JAMA, 288 (23). pp. 2981-2987.
dc.identifier.otherEprint ID 1253
dc.identifier.urihttp://hdl.handle.net/1903/23098
dc.subjectResearch
dc.subjectHypertension
dc.subjectChronic Illness & Diseases
dc.subjectHealth
dc.subjectAntihypertensive therapy
dc.subjecthypertension-related morbidity and mortality
dc.subjectcoronary heart disease
dc.titleMajor Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
dc.typeArticle

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