Mortality and morbidity during and after the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

Abstract

A randomized, double-blind, active-controlled, multicenter trial assigned 32,804 participants aged 55 years and older with hypertension and ≥ 1 other coronary heart disease risk factors to receive chlorthalidone (n=15,002), amlodipine (n=8898), or lisinopril (n=8904) for 4 to 8 years, when double-blinded therapy was discontinued. Passive surveillance continued for a total follow-up of 8 to 13 years using national administrative databases to ascertain deaths and hospitalizations. During the post-trial period, fatal outcomes and nonfatal outcomes were available for 98% and 65% of participants, respectively, due to lack of access to administrative databases for the remainder. This paper assesses whether mortality and morbidity differences persisted or new differences developed during the extended follow-up. Primary outcome was cardiovascular mortality and secondary outcomes were mortality, stroke, coronary heart disease, heart failure, cardiovascular disease, and end-stage renal disease. For the post-trial period, data are not available on medications or blood pressure levels. No significant differences (P<.05) appeared in cardiovascular mortality for amlodipine (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.93-1.06) or lisinopril (HR, 0.97; CI, 0.90-1.03), each compared with chlorthalidone. The only significant differences in secondary outcomes were for heart failure, which was higher with amlodipine (HR, 1.12; CI, 1.02-1.22), and stroke mortality, which was higher with lisinopril (HR, 1.20; CI, 1.01-1.41), each compared with chlorthalidone. Similar to the previously reported in-trial result, there was a significant treatment-by-race interaction for cardiovascular disease for lisinopril vs chlorthalidone. Black participants had higher risk than non-black participants taking lisinopril compared with chlorthalidone. After accounting for multiple comparisons, none of these results were significant. These findings suggest that neither calcium channel blockers nor angiotensin-converting enzyme inhibitors are superior to diuretics for the long-term prevention of major cardiovascular complications of hypertension.

• Authors: William C Cushman, Barry R Davis, Sara L Pressel, Jeffrey A Cutler, Paula T Einhorn, Charles E Ford, Suzanne Oparil, Jeffrey L Probstfield, Paul K Whelton, Jackson T Wright Jr, Michael H Alderman, Jan N Basile, Henry R Black, Richard H Grimm Jr, Bruce P Hamilton, L Julian Haywood, Stephen T Ong, Linda B Piller, Lara M Simpson, Carol Stanford, Robert J Weiss, ALLHAT Collaborative Research Group
• Journal: Journal of clinical hypertension (Greenwich, Conn.) (J Clin Hypertens (Greenwich)) Vol. 14 Issue 1 Pg. 20-31 (Jan 2012) ISSN: 1751-7176 [Electronic] United States
• PMID: 22235820 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: © 2011 Wiley Periodicals, Inc.

Chemical References

• Antihypertensive Agents
• Hypolipidemic Agents

Topics

• Acute Coronary Syndrome (ethnology, etiology, physiopathology, prevention & control)
• Aged
• Antihypertensive Agents (pharmacology, therapeutic use)
• Blood Pressure (drug effects)
• Double-Blind Method
• Female
• Follow-Up Studies
• Health Status Disparities
• Humans
• Hyperlipidemias (complications, drug therapy, ethnology, physiopathology)
• Hypertension (complications, drug therapy, ethnology, physiopathology)
• Hypolipidemic Agents (pharmacology, therapeutic use)
• Lipid Metabolism (drug effects)
• Male
• Middle Aged
• Mortality
• Outcome and Process Assessment, Health Care
• Population Surveillance
• Racial Groups (statistics & numerical data)
• United States (ethnology)