Key result
Treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up across eGFR strata.
Why the study?
Does amlodipine or lisinopril reduce cardiovascular mortality compared to chlorthalidone in older high-risk hypertensive patients across different baseline eGFR strata?
RCT (n=31,350)
randomized
Yes
Does amlodipine or lisinopril reduce cardiovascular mortality compared to chlorthalidone in older high-risk hypertensive patients across different baseline eGFR strata?
p-value: p=0.64 (amlodipine vs chlorthalidone), 0.56 (lisinopril vs chlorthalidone)
In older high-risk hypertensive patients, long-term treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events or mortality, regardless of baseline eGFR.
BACKGROUND AND OBJECTIVES: CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with chlorthalidone. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged ≥55 years, randomized to receive chlorthalidone, amlodipine, or lisinopril for 4-8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m(2)) as follows: normal/increased (≥90; n=8027), mild reduction (60-89; n=17,778), and moderate/severe reduction (<60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD. RESULTS: After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P<0.001). In participants with an eGFR <60, there was no significant difference in cardiovascular mortality between chlorthalidone and amlodipine (P=0.64), or chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD. CONCLUSIONS: CKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up. Because data on proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.
No takes yet. Share an insight, caveat, or question.
Rahman et al. (2012) conducted an RCT in Hypertension (n=31,350). Amlodipine or lisinopril vs. Chlorthalidone was evaluated on Cardiovascular mortality (p=0.64 (amlodipine vs chlorthalidone), 0.56 (lisinopril vs chlorthalidone)). Treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up across eGFR strata.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: