Key result
Neither lisinopril nor amlodipine significantly reduced combined fatal coronary artery disease or nonfatal myocardial infarction compared with chlorthalidone.
Why the study?
Does lisinopril or amlodipine reduce fatal coronary artery disease or nonfatal myocardial infarction compared with chlorthalidone?
RCT
Double-blind
parallel-group
Yes
Does lisinopril or amlodipine reduce fatal coronary artery disease or nonfatal myocardial infarction compared with chlorthalidone?
Lisinopril and amlodipine did not significantly reduce fatal CAD or nonfatal MI compared to chlorthalidone, supporting the efficacy of chlorthalidone in cardiovascular event reduction.
Answers are grounded in this paper and cite their sources.
Chlorthalidone should remain first-line for hypertension; reinforces thiazide-like diuretics over ACEIs or CCBs for coronary prevention in large RCTs.
he ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a multicenter, double-blinded, parallel-group, randomized controlled trial examining the effect of 4 different antihypertensive agents on the incidence of cardiovascular events. When comparing primary outcomes of combined fatal coronary artery disease or nonfatal myocardial infarction, neither lisinopril nor amlodipine use led to a significant reduction compared with chlorthalidone. Chlorthalidone did result in a significant reduction in combined coronary artery disease, stroke, congestive heart failure, and peripheral arterial disease and treated angina without hospitalization. In addition to antihypertensive randomization, patients with elevated low-density lipoprotein cholesterol were randomized to receive pravastatin or usual care.
No takes yet. Share an insight, caveat, or question.
McCaffrey et al. (2017) reported an RCT. Lisinopril or amlodipine vs. Chlorthalidone was evaluated on combined fatal coronary artery disease or nonfatal myocardial infarction. Neither lisinopril nor amlodipine significantly reduced combined fatal coronary artery disease or nonfatal myocardial infarction compared with chlorthalidone.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: