Does ALLHAT change the management of hypertension in chronic kidney disease?
ALLHAT was designed to test the hypothesis that "newer" antihypertensive agents are superior to a thiazide diuretic for cardiovascular outcomes. Pre-specified secondary outcomes included the development of end-stage renal disease (ESRD) (dialysis, renal transplantation, or death from renal cause) and estimated glomerular filtration rate (GFR). ALLHAT showed no differences in the overall rates of ESRD between those randomized to chlorthalidone, amlodipine, or lisinopril. It showed a slower rate of decline of GFR among those randomized to amlodipine in both diabetics and nondiabetics, and in the composite end point (ESRD or > or = 50% decline in GFR) in nondiabetics. The results of ALLHAT are consistent with other studies that, for the patient population studied (presumably largely nonalbuminuric patients with and without diabetes), at systolic BP > 130 mm Hg, there is no difference for renal outcomes between a thiazide diuretic, dihydropyridine calcium channel blocker, and ACEI-initiated treatment for 5 to 6 years of follow-up. These results suggest that BP control per se remains the most important objective for this patient population.
MacKinnon
Martin
M
Division of Nephrology and Kidney Research Centre, The Ottawa Hospital-Riverside Campus, Room 5-21, 1967 Riverside Drive, Ottawa, Ontario, Canada, K1H 7W9.
Leenen
Frans H H
FH
Ruzicka
Marcel
M
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004338:Drug Combinations; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000150:complications*; D012307:Risk Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D004338:Drug Combinations; D000960:Hypolipidemic Agents