title: Long-term follow-up of participants with heart failure in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT).
abstract: BACKGROUND
  In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in high-risk hypertensive participants, risk of new-onset heart failure (HF) was higher in the amlodipine (2.5-10 mg/d) and lisinopril (10-40 mg/d) arms compared with the chlorthalidone (12.5-25 mg/d) arm. Similar to other studies, mortality rates following new-onset HF were very high (≥50% at 5 years), and were similar across randomized treatment arms. After the randomized phase of the trial ended in 2002, outcomes were determined from administrative databases.
  
  
  RESULTS
  With the use of national databases, posttrial follow-up mortality through 2006 was obtained on participants who developed new-onset HF during the randomized (in-trial) phase of ALLHAT. Mean follow-up for the entire period was 8.9 years. Of 1761 participants with incident HF in-trial, 1348 died. Post-HF all-cause mortality was similar across treatment groups, with adjusted hazard ratios (95% confidence intervals) of 0.95 (0.81-1.12) and 1.05 (0.89-1.25), respectively, for amlodipine and lisinopril compared with chlorthalidone, and 10-year adjusted rates of 86%, 87%, and 83%, respectively. All-cause mortality rates were also similar among those with reduced ejection fractions (84%) and preserved ejection fractions (81%), with no significant differences by randomized treatment arm.
  
  
  CONCLUSIONS
  Once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with the development of HF is to be addressed. Clinical Trial Registration- http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
authors.affiliation: University of Texas School of Public Health, Houston, TX 77030, USA. Linda.B.Piller@uth.tmc.edu
authors.forename: Linda B
authors.initials: LB
authors.lastname: Piller
authors.forename: Sarah
authors.initials: S
authors.lastname: Baraniuk
authors.forename: Lara M
authors.initials: LM
authors.lastname: Simpson
authors.forename: William C
authors.initials: WC
authors.lastname: Cushman
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Paula T
authors.initials: PT
authors.lastname: Einhorn
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ford
authors.forename: James F
authors.initials: JF
authors.lastname: Graumlich
authors.forename: Richard A
authors.initials: RA
authors.lastname: Dart
authors.forename: David C
authors.initials: DC
authors.lastname: Parish
authors.forename: Tamrat M
authors.initials: TM
authors.lastname: Retta
authors.forename: Aloysius B
authors.initials: AB
authors.lastname: Cuyjet
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Jafri
authors.forename: Curt D
authors.initials: CD
authors.lastname: Furberg
authors.forename: Mohammad G
authors.initials: MG
authors.lastname: Saklayen
authors.forename: Udho
authors.initials: U
authors.lastname: Thadani
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Probstfield
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents