Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR.

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  • Additional Information
    • Corporate Authors:
      ALLHAT Collaborative Research Group
    • Source:
      Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101271570 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1555-905X (Electronic) Linking ISSN: 15559041 NLM ISO Abbreviation: Clin J Am Soc Nephrol Subsets: MEDLINE
    • Publication Information:
      Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health
      Original Publication: Washington, D.C. : American Society of Nephrology, c2005-
    • Subject Terms:
      Glomerular Filtration Rate*; Amlodipine/*therapeutic use ; Antihypertensive Agents/*therapeutic use ; Chlorthalidone/*therapeutic use ; Hypertension/*drug therapy ; Hypolipidemic Agents/*therapeutic use ; Kidney/*physiopathology ; Kidney Diseases/*drug therapy ; Lisinopril/*therapeutic use ; Myocardial Infarction/*prevention & control; Canada ; Chronic Disease ; Coronary Disease/etiology ; Coronary Disease/mortality ; Coronary Disease/prevention & control ; Double-Blind Method ; Female ; Heart Failure/etiology ; Heart Failure/mortality ; Heart Failure/prevention & control ; Humans ; Hypertension/complications ; Hypertension/mortality ; Hypertension/physiopathology ; Incidence ; Kaplan-Meier Estimate ; Kidney Diseases/complications ; Kidney Diseases/mortality ; Kidney Diseases/physiopathology ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/prevention & control ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/etiology ; Myocardial Infarction/mortality ; Myocardial Infarction/physiopathology ; Proportional Hazards Models ; Puerto Rico ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke/etiology ; Stroke/mortality ; Stroke/prevention & control ; Time Factors ; Treatment Outcome ; United States ; United States Virgin Islands
    • Abstract:
      Background and Objectives: CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with chlorthalidone.
      Design, Setting, Participants, & Measurements: This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged ≥55 years, randomized to receive chlorthalidone, amlodipine, or lisinopril for 4-8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m(2)) as follows: normal/increased (≥90; n=8027), mild reduction (60-89; n=17,778), and moderate/severe reduction (<60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD.
      Results: After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P<0.001). In participants with an eGFR <60, there was no significant difference in cardiovascular mortality between chlorthalidone and amlodipine (P=0.64), or chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD.
      Conclusions: CKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up. Because data on proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.
    • Comments:
      Comment in: Clin J Am Soc Nephrol. 2012 Jun;7(6):884-6. (PMID: 22595830)
      Comment in: Expert Rev Cardiovasc Ther. 2012 Oct;10(10):1213-6. (PMID: 23190060)
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    • Grant Information:
      N01HC35130 United States HL NHLBI NIH HHS; UL1 RR024148 United States RR NCRR NIH HHS; UL1 TR000439 United States TR NCATS NIH HHS; N01-HC-3513 United States HC NHLBI NIH HHS
    • Contributed Indexing:
      Investigator: CD Furberg; JT Wright; BR Davis; JA Cutler; M Alderman; H Black; W Cushman; R Grimm; L Haywood; F Leenen; S Oparil; J Probstfield; P Whelton; C Nwachuku; D Gordon; M Proschan; P Einhorn; CE Ford; LB Piller; J Dunn; D Goff; S Pressel; J Bettencourt; B deLeon; LM Simpson; J Blanton; T Geraci; SM Walsh; C Nelson; M Rahman; A Juratovac; R Pospisil; L Carroll; S Sullivan; J Russo; G Barone; R Christian; S Feldman; T Lucente; D Calhoun; K Jenkins; P McDowell; J Johnson; C Kingry; J Alzate; KL Margolis; LA Holland-Klemme; B Jaeger; J Williamson; G Louis; P Ragusa; A Williard; RL Ferguson; J Tanner; J Eckfeldt; R Crow; J Pelosi
    • Molecular Sequence:
      ClinicalTrials.gov NCT00000542
    • Accession Number:
      0 (Antihypertensive Agents)
      0 (Hypolipidemic Agents)
      1J444QC288 (Amlodipine)
      E7199S1YWR (Lisinopril)
      Q0MQD1073Q (Chlorthalidone)
    • Publication Date:
      Date Created: 20120412 Date Completed: 20121016 Latest Revision: 20240322
    • Publication Date:
      20240322
    • Accession Number:
      PMC3362309
    • Accession Number:
      10.2215/CJN.07800811
    • Accession Number:
      22490878