Amlodipine or lisinopril was not better than chlorthalidone in lowering CHD risk in hypertension
Why the study?
Does amlodipine or lisinopril reduce CHD or other cardiovascular disease events compared to chlorthalidone in older patients with hypertension and ≥1 other CHD risk factor?
Population
33,357 patients ≥55 years of age with stage 1 or stage 2 hypertension and ≥1 additional risk factor for CHD…
Comparison
Amlodipine or lisinopril vs Chlorthalidone
Design
RCT, allocation concealed, blinded
Follow-up
mean 4.9 years
Authors
Discussion
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Member takes
Implication
Chlorthalidone remains appropriate first-line therapy in high-risk hypertension; confirms no CHD benefit from amlodipine or lisinopril over diuretic.
Structured PICO
Does amlodipine or lisinopril reduce CHD or other cardiovascular disease events compared to chlorthalidone in older patients with hypertension and ≥1 other CHD risk factor?
P
Population
33,357 patients ≥55 years of age (mean age 67 y, 53% men) with stage 1 or stage 2 hypertension and ≥1 additional risk factor for CHD (myocardial infarction or stroke in the previous 6 months, left ventricular hypertrophy, type 2 diabetes, smoking, high density lipoprotein cholesterol <0.91 mmol/l, or other atherosclerotic CVD). Excluded: history of heart failure or known left ventricular ejection fraction <35%.
I
Intervention
Amlodipine or lisinopril
C
Comparator
Chlorthalidone
O
Outcome
Coronary heart disease (CHD) or other cardiovascular disease (CVD) eventshard clinical
In high-risk hypertensive patients, treatment with amlodipine or lisinopril did not demonstrate superiority over the diuretic chlorthalidone in reducing the risk of coronary heart disease.
Cite This Study
Bruce M. Psaty (2003) studied this question.