Key result
Pre-entry antihypertensive drug type did not significantly explain the observed differences in hospitalized heart failure by ALLHAT treatment, with an interaction OR of 1.08 for amlodipine versus chlorthalidone in patients taking prior diuretics.
Why the study?
Does pre-entry antihypertensive medication influence the risk of hospitalized heart failure among patients randomized to different antihypertensive treatments in the ALLHAT trial?
Observational (n=1,418)
Double-blind
null
Yes
Does pre-entry antihypertensive medication influence the risk of hospitalized heart failure among patients randomized to different antihypertensive treatments in the ALLHAT trial?
Effect estimate: Interaction OR 1.08 (95% CI 0.53-2.21)
p-value: p=0.83
Pre-enrollment antihypertensive medication type did not explain the early differences in hospitalized heart failure rates observed between chlorthalidone and other antihypertensive treatments in the ALLHAT trial.
Pre-entry antihypertensive type does not explain ALLHAT HF differences; leaves open alternative mechanisms and should not yet alter practice.
J Clin Hypertens (Greenwich). 2009;11:466-474. (c)2009 Wiley Periodicals, Inc.Lower heart failure (HF) rates in individuals taking chlorthalidone vs amlodipine, lisinopril, or doxazosin were unanticipated in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). HF differences appeared early, leading to questions about the possible influence of pre-enrollment antihypertensive drugs. A post hoc study evaluated hospitalized HF events. During year 1479 individuals had HF, with pre-entry antihypertensive medication data obtained on 301 patients (63%). Case-only analysis examined interactive effects (interaction odds ratio [OR, ratio of ORs]) of previous medication and ALLHAT treatment on HF outcomes, eg, did treatment effect differ by pre-entry antihypertensive class? Among cases, 39%, 37%, 17%, and 47% were taking pre-entry diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, and calcium channel blockers, respectively. Interaction OR for year 1 HF for amlodipine vs chlorthalidone for patients taking vs not taking diuretics pre-entry was 1.08 (95% confidence interval [CI], 0.53-2.21; P=.83); for lisinopril vs chlorthalidone, 1.33 (95% CI, 0.65-2.74; P=.44); and for doxazosin vs chlorthalidone, 1.13 (95% CI, 0.57-2.25; P=.73). Controlling for other pre-entry antihypertensives yielded similar results. There was no significant evidence that pre-entry drug type explained observed hospitalized HF differences by ALLHAT treatment.
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Grimm et al. (2009) conducted an observational in Hypertension with at least 1 additional risk factor for CHD (n=1,418). Pre-entry antihypertensive medication (diuretics, ACE inhibitors, calcium channel blockers, beta-blockers) and ALLHAT treatment vs. No prior medication and chlorthalidone was evaluated on Interaction of pre-entry diuretic use and ALLHAT treatment (amlodipine vs chlorthalidone) on year 1 hospitalized heart failure (Interaction OR 1.08, 95% CI 0.53-2.21, p=0.83). Pre-entry antihypertensive drug type did not significantly explain the observed differences in hospitalized heart failure by ALLHAT treatment, with an interaction OR of 1.08 for amlodipine versus chlorthalidone in patients taking prior diuretics.
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