Mortality and Morbidity During and After the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial
Key result
Neither amlodipine (HR 1.00; 95% CI 0.93-1.06) nor lisinopril (HR 0.97; 95% CI 0.90-1.03) was superior to chlorthalidone for long-term prevention of cardiovascular mortality.
Why the study?
Do amlodipine or lisinopril reduce cardiovascular mortality compared to chlorthalidone in participants aged 55 years and older with hypertension and ≥ 1 other coronary heart disease risk factors?
Population
32,804 participants aged 55 years and older with hypertension and ≥ 1 other coronary heart disease risk…
Comparison
Amlodipine or lisinopril for 4 to 8 years vs Chlorthalidone (n=15,002) for 4 to 8 years
Design
RCT, randomized, double-blind
Follow-up
8 to 13 years total follow-up
Authors
Discussion
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Member takes
Implication
Affirms chlorthalidone as preferred initial therapy in high-risk hypertension; confirms long-term ALLHAT findings on cardiovascular outcomes.
Study Design
Type
RCT (n=32,804)
Blinding
Double-blind
Randomization
Randomized
Multicenter
Yes
Structured PICO
Do amlodipine or lisinopril reduce cardiovascular mortality compared to chlorthalidone in participants aged 55 years and older with hypertension and ≥ 1 other coronary heart disease risk factors?
P
Population
32,804 participants aged 55 years and older with hypertension and ≥ 1 other coronary heart disease risk factors
I
Intervention
Amlodipine (n=8898) or lisinopril (n=8904) for 4 to 8 years
C
Comparator
Chlorthalidone (n=15,002) for 4 to 8 years
O
Outcome
Cardiovascular mortalityhard clinical
Main Result
Effect estimate: HR 1.00 (amlodipine); HR 0.97 (lisinopril) (95% CI 0.93-1.06 (amlodipine); 0.90-1.03 (lisinopril))
p-value: p=>0.05
Long-term follow-up of the ALLHAT trial confirms that neither calcium channel blockers nor ACE inhibitors are superior to thiazide-type diuretics for preventing major cardiovascular complications of hypertension.
Limitations
- Nonfatal outcomes were available for only 65% of participants due to lack of access to administrative databases
- Data are not available on medications or blood pressure levels for the post-trial period
- For the post-trial period, data are not available on medications or blood pressure levels
- 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
Cite This Study
Cushman et al. (2011) conducted an RCT in Hypertension (n=32,804). Amlodipine or lisinopril vs. Chlorthalidone was evaluated on Cardiovascular mortality (HR 1.00 (amlodipine); HR 0.97 (lisinopril), 95% CI 0.93-1.06 (amlodipine); 0.90-1.03 (lisinopril), p=>0.05). Neither amlodipine (HR 1.00; 95% CI 0.93-1.06) nor lisinopril (HR 0.97; 95% CI 0.90-1.03) was superior to chlorthalidone for long-term prevention of cardiovascular mortality.