title: Heart failure in ALLHAT: did blood pressure medication at study entry influence outcome?
abstract: J Clin Hypertens (Greenwich). 2009;11:466-474. (c)2009 Wiley Periodicals, Inc.Lower heart failure (HF) rates in individuals taking chlorthalidone vs amlodipine, lisinopril, or doxazosin were unanticipated in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). HF differences appeared early, leading to questions about the possible influence of pre-enrollment antihypertensive drugs. A post hoc study evaluated hospitalized HF events. During year 1479 individuals had HF, with pre-entry antihypertensive medication data obtained on 301 patients (63%). Case-only analysis examined interactive effects (interaction odds ratio [OR, ratio of ORs]) of previous medication and ALLHAT treatment on HF outcomes, eg, did treatment effect differ by pre-entry antihypertensive class? Among cases, 39%, 37%, 17%, and 47% were taking pre-entry diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, and calcium channel blockers, respectively. Interaction OR for year 1 HF for amlodipine vs chlorthalidone for patients taking vs not taking diuretics pre-entry was 1.08 (95% confidence interval [CI], 0.53-2.21; P=.83); for lisinopril vs chlorthalidone, 1.33 (95% CI, 0.65-2.74; P=.44); and for doxazosin vs chlorthalidone, 1.13 (95% CI, 0.57-2.25; P=.73). Controlling for other pre-entry antihypertensives yielded similar results. There was no significant evidence that pre-entry drug type explained observed hospitalized HF differences by ALLHAT treatment.
authors.affiliation: Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Grimm
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.forename: Linda B
authors.initials: LB
authors.lastname: Piller
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cutler
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Joshua
authors.initials: J
authors.lastname: Barzilay
authors.forename: Richard A
authors.initials: RA
authors.lastname: Dart
authors.forename: James F
authors.initials: JF
authors.lastname: Graumlich
authors.forename: Robert A
authors.initials: RA
authors.lastname: Murden
authors.forename: Otelio S
authors.initials: OS
authors.lastname: Randall
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016001:Confidence Intervals; D004311:Double-Blind Method; D017292:Doxazosin / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000317:Adrenergic alpha-Antagonists; D000959:Antihypertensive Agents; D017292:Doxazosin