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Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial.

Abstract

The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm.

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  • Authors+Show Affiliations

    ,

    University of Ottawa Heart Institute, Ottawa, Ontario, Canada. fleenen@ottawaheart.ca

    , , , , , , , , , , , , , , , , , ,

    Source

    Hypertension (Dallas, Tex. : 1979) 48:3 2006 Sep pg 374-84

    MeSH

    African Continental Ancestry Group
    Amlodipine
    Angioedema
    Angiotensin-Converting Enzyme Inhibitors
    Blood Glucose
    Blood Pressure
    Calcium Channel Blockers
    Cardiac Output, Low
    Cardiovascular Diseases
    Coronary Disease
    Female
    Gastrointestinal Hemorrhage
    Glomerular Filtration Rate
    Humans
    Hypertension
    Hypertrophy, Left Ventricular
    Hypolipidemic Agents
    Incidence
    Lisinopril
    Male
    Middle Aged
    Myocardial Infarction
    Risk
    Sex Distribution

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16864749

    Citation

    Leenen, Frans H H., et al. "Clinical Events in High-risk Hypertensive Patients Randomly Assigned to Calcium Channel Blocker Versus Angiotensin-converting Enzyme Inhibitor in the Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial." Hypertension (Dallas, Tex. : 1979), vol. 48, no. 3, 2006, pp. 374-84.
    Leenen FH, Nwachuku CE, Black HR, et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension. 2006;48(3):374-84.
    Leenen, F. H., Nwachuku, C. E., Black, H. R., Cushman, W. C., Davis, B. R., Simpson, L. M., ... Wright, J. T. (2006). Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension (Dallas, Tex. : 1979), 48(3), pp. 374-84.
    Leenen FH, et al. Clinical Events in High-risk Hypertensive Patients Randomly Assigned to Calcium Channel Blocker Versus Angiotensin-converting Enzyme Inhibitor in the Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial. Hypertension. 2006;48(3):374-84. PubMed PMID: 16864749.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. AU - Leenen,Frans H H, AU - Nwachuku,Chuke E, AU - Black,Henry R, AU - Cushman,William C, AU - Davis,Barry R, AU - Simpson,Lara M, AU - Alderman,Michael H, AU - Atlas,Steven A, AU - Basile,Jan N, AU - Cuyjet,Aloysius B, AU - Dart,Richard, AU - Felicetta,James V, AU - Grimm,Richard H, AU - Haywood,L Julian, AU - Jafri,Syed Z A, AU - Proschan,Michael A, AU - Thadani,Udho, AU - Whelton,Paul K, AU - Wright,Jackson T, AU - ,, Y1 - 2006/07/24/ PY - 2006/7/26/pubmed PY - 2006/9/19/medline PY - 2006/7/26/entrez SP - 374 EP - 84 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 48 IS - 3 N2 - The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/16864749/full_citation L2 - http://www.ahajournals.org/doi/full/10.1161/01.HYP.0000231662.77359.de?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -