February 7, 2006Annals of Internal Medicine
Cardiovascular Outcomes in High-Risk Hypertensive Patients Stratified by Baseline Glomerular Filtration Rate
Why the study?
Does first-step treatment with amlodipine or lisinopril compared to chlorthalidone reduce cardiovascular and renal events in high-risk hypertensive patients stratified by baseline GFR?
Population
31,897 persons with hypertension who were 55 years of age or older with 1 or more risk factors for CHD…
Comparison
First-step treatment with amlodipine or lisinopril vs First-step treatment with chlorthalidone
Design
RCT, Random assignment, double-blind
Follow-up
6-year
Authors
Discussion
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Implication
Chlorthalidone preferred initially in high-risk hypertension; extends heart failure benefit across all baseline GFR levels.
Structured PICO
Does first-step treatment with amlodipine or lisinopril compared to chlorthalidone reduce cardiovascular and renal events in high-risk hypertensive patients stratified by baseline GFR?
P
Population
31,897 persons with hypertension who were 55 years of age or older with 1 or more risk factors for CHD, stratified into 3 baseline GFR groups: normal or increased (>= 90 mL/min per 1.73 m2; n = 8126), mild reduction (60 to 89 mL/min per 1.73 m2; n = 18,109), and moderate or severe reduction (< 60 mL/min per 1.73 m2; n = 5662).
I
Intervention
First-step treatment with amlodipine or lisinopril
C
Comparator
First-step treatment with chlorthalidone
O
Outcome
Rates of coronary heart disease (CHD) and end-stage renal disease (ESRD)hard clinical
In older, high-risk hypertensive patients, chlorthalidone is superior to amlodipine and lisinopril for preventing heart failure across all levels of baseline renal function, while providing similar protection against CHD.
Limitations
- Proteinuria data were not available
- Combination therapies were not tested
Cite This Study
Rahman et al. (2006) studied this question.