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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.
Clin J Am Soc Nephrol 2012; 7(6):989-1002CJ

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.

Authors+Show Affiliations

Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

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 -