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Influence of Prevalent and Incident Atrial Fibrillation on Post-Trial Major Events in ALLHAT.
J Natl Med Assoc. 2017 Autumn; 109(3):172-181.JN

Abstract

AIMS

Limited information is available on long-term antihypertensive and lipid-lowering therapy effects on hypertensive patients with atrial fibrillation/flutter (AF/AFL) compared to those without. AF/AFL at baseline or during the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (mean follow-up 4.9 years) markedly increased risk of stroke, heart failure, CHD, and all-cause mortality. We aimed to determine if AF/AFL continued to impact outcomes during post-trial follow-up (mean 3.8 years).

METHODS

Patients were randomized to chlorthalidone, amlodipine, or lisinopril, and to pravastatin vs. usual care in the lipid-lowering trial (LLT). Of 31,473 available subjects, AF/AFL occurred in 854; 383/14,371 chlorthalidone (2.7%), 247/8565 amlodipine (2.9%), and 224/8537 lisinopril (2.6%). Post-hoc analyses utilized administrative databases for post-trial data. Individuals with AF/AFL were compared to those without during post-trial. Outcomes were analyzed by treatment groups for the antihypertensive and LLT trials.

RESULTS

Among 854 AF/AFL participants, 491 (57.5%) died: 220 in-trial, 271 post-trial. Ten-year all-cause mortality rates for those with in-trial AF/AFL were similar for chlorthalidone and lisinopril, but lower for amlodipine (68, 66, and 49 per 100 persons, respectively); adjusted HR for amlodipine vs. chlorthalidone was 0.68 (95% CI, 0.54-0.87). Ten-year all-cause mortality rates were 57 vs. 65 per 100 persons (pravastatin vs. usual care); non-CVD mortality rates, 18 vs. 39 per 100 persons (pravastatin vs. usual care) (adjusted HR = 0.46, 95% CI, 0.24-0.86).

CONCLUSION

Post-trial follow-up revealed continued deleterious AF/AFL effects. The amlodipine (ALLHAT) and pravastatin (ALLHAT-LLT) treatment groups showed lower all-cause and non-CVD mortality compared to the chlorthalidone and usual-care groups, respectively.

Authors+Show Affiliations

LAC+USC Medical Center, Keck School of Medicine, Los Angeles, CA, USA.Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston, TX, USA.Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston, TX, USA. Electronic address: Linda.B.Piller@uth.tmc.edu.Preventive Medicine Section, Veterans Affairs Medical Center, University of Tennessee Health Science Center, USA.Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston, TX, USA.Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston, TX, USA.Coordinating Center for Clinical Trials, University of Texas School of Public Health, Houston, TX, USA.Epidemiological Cardiology Research Center (EPICARE), Wake Forest University School of Medicine, Winston-Salem, NC, USA.W T Dahms Clinical Research Unit, University Hospitals Case Medical Center, Cleveland, OH, USA.No affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28987246

Citation

Haywood, L Julian, et al. "Influence of Prevalent and Incident Atrial Fibrillation On Post-Trial Major Events in ALLHAT." Journal of the National Medical Association, vol. 109, no. 3, 2017, pp. 172-181.
Haywood LJ, Davis BR, Piller LB, et al. Influence of Prevalent and Incident Atrial Fibrillation on Post-Trial Major Events in ALLHAT. J Natl Med Assoc. 2017;109(3):172-181.
Haywood, L. J., Davis, B. R., Piller, L. B., Cushman, W. C., Cutler, J. A., Ford, C. E., Simpson, L. M., Ghosh, A., Soliman, E. Z., & Wright, J. T. (2017). Influence of Prevalent and Incident Atrial Fibrillation on Post-Trial Major Events in ALLHAT. Journal of the National Medical Association, 109(3), 172-181. https://doi.org/10.1016/j.jnma.2017.02.005
Haywood LJ, et al. Influence of Prevalent and Incident Atrial Fibrillation On Post-Trial Major Events in ALLHAT. J Natl Med Assoc. 2017 Autumn;109(3):172-181. PubMed PMID: 28987246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of Prevalent and Incident Atrial Fibrillation on Post-Trial Major Events in ALLHAT. AU - Haywood,L Julian, AU - Davis,Barry R, AU - Piller,Linda B, AU - Cushman,William C, AU - Cutler,Jeffrey A, AU - Ford,Charles E, AU - Simpson,Lara M, AU - Ghosh,Alokananda, AU - Soliman,Elsayed Z, AU - Wright,Jackson T,Jr AU - ,, Y1 - 2017/03/18/ PY - 2016/10/19/received PY - 2017/02/14/revised PY - 2017/02/14/accepted PY - 2017/10/9/entrez PY - 2017/10/11/pubmed PY - 2019/7/6/medline KW - Antihypertensive therapy KW - Atrial fibrillation KW - Heart failure KW - Stroke SP - 172 EP - 181 JF - Journal of the National Medical Association JO - J Natl Med Assoc VL - 109 IS - 3 N2 - AIMS: Limited information is available on long-term antihypertensive and lipid-lowering therapy effects on hypertensive patients with atrial fibrillation/flutter (AF/AFL) compared to those without. AF/AFL at baseline or during the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (mean follow-up 4.9 years) markedly increased risk of stroke, heart failure, CHD, and all-cause mortality. We aimed to determine if AF/AFL continued to impact outcomes during post-trial follow-up (mean 3.8 years). METHODS: Patients were randomized to chlorthalidone, amlodipine, or lisinopril, and to pravastatin vs. usual care in the lipid-lowering trial (LLT). Of 31,473 available subjects, AF/AFL occurred in 854; 383/14,371 chlorthalidone (2.7%), 247/8565 amlodipine (2.9%), and 224/8537 lisinopril (2.6%). Post-hoc analyses utilized administrative databases for post-trial data. Individuals with AF/AFL were compared to those without during post-trial. Outcomes were analyzed by treatment groups for the antihypertensive and LLT trials. RESULTS: Among 854 AF/AFL participants, 491 (57.5%) died: 220 in-trial, 271 post-trial. Ten-year all-cause mortality rates for those with in-trial AF/AFL were similar for chlorthalidone and lisinopril, but lower for amlodipine (68, 66, and 49 per 100 persons, respectively); adjusted HR for amlodipine vs. chlorthalidone was 0.68 (95% CI, 0.54-0.87). Ten-year all-cause mortality rates were 57 vs. 65 per 100 persons (pravastatin vs. usual care); non-CVD mortality rates, 18 vs. 39 per 100 persons (pravastatin vs. usual care) (adjusted HR = 0.46, 95% CI, 0.24-0.86). CONCLUSION: Post-trial follow-up revealed continued deleterious AF/AFL effects. The amlodipine (ALLHAT) and pravastatin (ALLHAT-LLT) treatment groups showed lower all-cause and non-CVD mortality compared to the chlorthalidone and usual-care groups, respectively. SN - 0027-9684 UR - https://www.unboundmedicine.com/medline/citation/28987246/Influence_of_Prevalent_and_Incident_Atrial_Fibrillation_on_Post_Trial_Major_Events_in_ALLHAT_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0027-9684(16)30153-5 DB - PRIME DP - Unbound Medicine ER -