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

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.

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  • Authors+Show Affiliations

    ,

    Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, USA.

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

    Source

    MeSH

    Amlodipine
    Antihypertensive Agents
    Canada
    Chlorthalidone
    Chronic Disease
    Coronary Disease
    Double-Blind Method
    Female
    Glomerular Filtration Rate
    Heart Failure
    Humans
    Hypertension
    Hypolipidemic Agents
    Incidence
    Kaplan-Meier Estimate
    Kidney
    Kidney Diseases
    Kidney Failure, Chronic
    Lisinopril
    Male
    Middle Aged
    Multivariate Analysis
    Myocardial Infarction
    Proportional Hazards Models
    Puerto Rico
    Risk Assessment
    Risk Factors
    Severity of Illness Index
    Stroke
    Time Factors
    Treatment Outcome
    United States
    United States Virgin Islands

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    22490878

    Citation

    Rahman, Mahboob, et al. "Long-term Renal and Cardiovascular Outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants By Baseline Estimated GFR." Clinical Journal of the American Society of Nephrology : CJASN, vol. 7, no. 6, 2012, pp. 989-1002.
    Rahman M, Ford CE, Cutler JA, et al. Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR. Clin J Am Soc Nephrol. 2012;7(6):989-1002.
    Rahman, M., Ford, C. E., Cutler, J. A., Davis, B. R., Piller, L. B., Whelton, P. K., ... Preston, R. (2012). Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR. Clinical Journal of the American Society of Nephrology : CJASN, 7(6), pp. 989-1002. doi:10.2215/CJN.07800811.
    Rahman M, et al. Long-term Renal and Cardiovascular Outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants By Baseline Estimated GFR. Clin J Am Soc Nephrol. 2012;7(6):989-1002. PubMed PMID: 22490878.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR. AU - Rahman,Mahboob, AU - Ford,Charles E, AU - Cutler,Jeffrey A, AU - Davis,Barry R, AU - Piller,Linda B, AU - Whelton,Paul K, AU - Wright,Jackson T,Jr AU - Barzilay,Joshua I, AU - Brown,Clinton D, AU - Colon,Pedro J,Sr AU - Fine,Lawrence J, AU - Grimm,Richard H,Jr AU - Gupta,Alok K, AU - Baimbridge,Charles, AU - Haywood,L Julian, AU - Henriquez,Mario A, AU - Ilamaythi,Ekambaram, AU - Oparil,Suzanne, AU - Preston,Richard, AU - ,, Y1 - 2012/04/05/ PY - 2012/4/12/entrez PY - 2012/4/12/pubmed PY - 2012/10/17/medline SP - 989 EP - 1002 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 7 IS - 6 N2 - 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. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/22490878/Long_term_renal_and_cardiovascular_outcomes_in_Antihypertensive_and_Lipid_Lowering_Treatment_to_Prevent_Heart_Attack_Trial__ALLHAT__participants_by_baseline_estimated_GFR_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=22490878 DB - PRIME DP - Unbound Medicine ER -