Effect of Chlorthalidone, Amlodipine, and Lisinopril on Visit‐to‐Visit Variability of Blood Pressure: Results From the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial
Key result
Chlorthalidone and amlodipine reduce SBP visit-to-visit variability by ~14% compared to lisinopril.
- Amlodipine: -0.36 (SE 0.07); Lisinopril: +0.77 (SE 0.08)
- n=24,004
Why the study?
Does amlodipine or lisinopril compared to chlorthalidone improve visit-to-visit variability of systolic blood pressure in hypertensive patients?
Population
24,004 participants from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
Comparison
Amlodipine or lisinopril vs Chlorthalidone
Design
RCT, Randomized to chlorthalidone, amlodipine, or lisinopril
Follow-up
6 to 28 months
Authors
Discussion
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Implication
May guide choice of chlorthalidone or amlodipine over lisinopril to reduce SBP variability; extends RCT evidence on class-specific effects beyond mean BP.
Study Design
Type
RCT (n=24,004)
Structured PICO
Does amlodipine or lisinopril compared to chlorthalidone improve visit-to-visit variability of systolic blood pressure in hypertensive patients?
P
Population
24,004 participants from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
I
Intervention
Amlodipine or lisinopril
C
Comparator
Chlorthalidone
O
Outcome
Visit-to-visit variability (VVV) of systolic blood pressure (SBP) calculated across 5 to 7 visits occurring 6 to 28 months following randomizationsurrogate
Main Result
Effect estimate: Amlodipine: -0.36 (SE 0.07); Lisinopril: +0.77 (SE 0.08)
Chlorthalidone and amlodipine are associated with lower visit-to-visit variability of systolic blood pressure compared to lisinopril.
Cite This Study
Muntner et al. (2014) conducted an RCT in Hypertension (n=24,004). Amlodipine and lisinopril vs. Chlorthalidone was evaluated on Visit-to-visit variability (VVV) of systolic blood pressure (SBP) (Amlodipine: -0.36 (SE 0.07); Lisinopril: +0.77 (SE 0.08)). Chlorthalidone and amlodipine were associated with lower visit-to-visit variability of systolic blood pressure than lisinopril (SD of SBP 10.6 and 10.5 vs 12.2, respectively).