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Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex.

Abstract

To determine whether an angiotensin-converting enzyme inhibitor (lisinopril) or calcium channel blocker (amlodipine) is superior to a diuretic (chlorthalidone) in reducing cardiovascular disease incidence in sex subgroups, we carried out a prespecified subgroup analysis of 15 638 women and 17 719 men in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Total follow-up (active treatment + passive surveillance using national administrative databases to ascertain deaths and hospitalizations) was 8 to 13 years. The primary outcome was fatal coronary heart disease or nonfatal myocardial infarction. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (coronary heart disease death, nonfatal myocardial infarction, stroke, angina, coronary revascularization, heart failure [HF], or peripheral vascular disease), and end-stage renal disease. In-trial rates of HF, stroke, and combined cardiovascular disease were significantly higher for lisinopril compared with chlorthalidone, and rates of HF were significantly higher for amlodipine compared with chlorthalidone in both men and women. There were no significant treatment sex interactions. These findings did not persist through the extension period with the exception of the HF result for amlodipine versus chlorthalidone, which did not differ significantly by sex. For both women and men, rates were not lower in the amlodipine or lisinopril groups than in the chlorthalidone group for either the primary coronary heart disease outcome or any other cardiovascular disease outcome, and chlorthalidone-based treatment resulted in the lowest risk of HF. Neither lisinopril nor amlodipine is superior to chlorthalidone for initial treatment of hypertension in either women or men. Clinical Trial Registration- clinicaltrials.gov; Identifier: NCT00000542.

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  • Authors+Show Affiliations

    ,

    University of Alabama at Birmingham, Birmingham, AL, USA.

    , , , , , , , , , ,

    Source

    Hypertension (Dallas, Tex. : 1979) 61:5 2013 May pg 977-86

    MeSH

    Aged
    Aged, 80 and over
    Amlodipine
    Antihypertensive Agents
    Calcium Channel Blockers
    Chlorthalidone
    Coronary Disease
    Diuretics
    Female
    Follow-Up Studies
    Heart Failure
    Humans
    Hypertension
    Hypolipidemic Agents
    Incidence
    Lisinopril
    Longitudinal Studies
    Male
    Middle Aged
    Myocardial Infarction
    Risk Factors
    Sex Factors
    Stroke

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    23529173

    Citation

    Oparil, Suzanne, et al. "Mortality and Morbidity During and After Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: Results By Sex." Hypertension (Dallas, Tex. : 1979), vol. 61, no. 5, 2013, pp. 977-86.
    Oparil S, Davis BR, Cushman WC, et al. Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex. Hypertension. 2013;61(5):977-86.
    Oparil, S., Davis, B. R., Cushman, W. C., Ford, C. E., Furberg, C. D., Habib, G. B., ... Wright, J. T. (2013). Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex. Hypertension (Dallas, Tex. : 1979), 61(5), pp. 977-86. doi:10.1161/HYPERTENSIONAHA.111.00213.
    Oparil S, et al. Mortality and Morbidity During and After Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: Results By Sex. Hypertension. 2013;61(5):977-86. PubMed PMID: 23529173.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Mortality and morbidity during and after Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: results by sex. AU - Oparil,Suzanne, AU - Davis,Barry R, AU - Cushman,William C, AU - Ford,Charles E, AU - Furberg,Curt D, AU - Habib,Gabriel B, AU - Haywood,L Julian, AU - Margolis,Karen, AU - Probstfield,Jeffrey L, AU - Whelton,Paul K, AU - Wright,Jackson T,Jr AU - ,, Y1 - 2013/03/25/ PY - 2013/3/27/entrez PY - 2013/3/27/pubmed PY - 2013/7/6/medline SP - 977 EP - 86 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 61 IS - 5 N2 - To determine whether an angiotensin-converting enzyme inhibitor (lisinopril) or calcium channel blocker (amlodipine) is superior to a diuretic (chlorthalidone) in reducing cardiovascular disease incidence in sex subgroups, we carried out a prespecified subgroup analysis of 15 638 women and 17 719 men in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Total follow-up (active treatment + passive surveillance using national administrative databases to ascertain deaths and hospitalizations) was 8 to 13 years. The primary outcome was fatal coronary heart disease or nonfatal myocardial infarction. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (coronary heart disease death, nonfatal myocardial infarction, stroke, angina, coronary revascularization, heart failure [HF], or peripheral vascular disease), and end-stage renal disease. In-trial rates of HF, stroke, and combined cardiovascular disease were significantly higher for lisinopril compared with chlorthalidone, and rates of HF were significantly higher for amlodipine compared with chlorthalidone in both men and women. There were no significant treatment sex interactions. These findings did not persist through the extension period with the exception of the HF result for amlodipine versus chlorthalidone, which did not differ significantly by sex. For both women and men, rates were not lower in the amlodipine or lisinopril groups than in the chlorthalidone group for either the primary coronary heart disease outcome or any other cardiovascular disease outcome, and chlorthalidone-based treatment resulted in the lowest risk of HF. Neither lisinopril nor amlodipine is superior to chlorthalidone for initial treatment of hypertension in either women or men. Clinical Trial Registration- clinicaltrials.gov; Identifier: NCT00000542. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/23529173/Mortality_and_morbidity_during_and_after_Antihypertensive_and_Lipid_Lowering_Treatment_to_Prevent_Heart_Attack_Trial:_results_by_sex_ L2 - http://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.111.00213?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -