title: Mortality and morbidity during and after the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.
abstract: A randomized, double-blind, active-controlled, multicenter trial assigned 32,804 participants aged 55 years and older with hypertension and ≥ 1 other coronary heart disease risk factors to receive chlorthalidone (n=15,002), amlodipine (n=8898), or lisinopril (n=8904) for 4 to 8 years, when double-blinded therapy was discontinued. Passive surveillance continued for a total follow-up of 8 to 13 years using national administrative databases to ascertain deaths and hospitalizations. During the post-trial period, fatal outcomes and nonfatal outcomes were available for 98% and 65% of participants, respectively, due to lack of access to administrative databases for the remainder. This paper assesses whether mortality and morbidity differences persisted or new differences developed during the extended follow-up. Primary outcome was cardiovascular mortality and secondary outcomes were mortality, stroke, coronary heart disease, heart failure, cardiovascular disease, and end-stage renal disease. For the post-trial period, data are not available on medications or blood pressure levels. No significant differences (P<.05) appeared in cardiovascular mortality for amlodipine (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.93-1.06) or lisinopril (HR, 0.97; CI, 0.90-1.03), each compared with chlorthalidone. The only significant differences in secondary outcomes were for heart failure, which was higher with amlodipine (HR, 1.12; CI, 1.02-1.22), and stroke mortality, which was higher with lisinopril (HR, 1.20; CI, 1.01-1.41), each compared with chlorthalidone. Similar to the previously reported in-trial result, there was a significant treatment-by-race interaction for cardiovascular disease for lisinopril vs chlorthalidone. Black participants had higher risk than non-black participants taking lisinopril compared with chlorthalidone. After accounting for multiple comparisons, none of these results were significant. These findings suggest that neither calcium channel blockers nor angiotensin-converting enzyme inhibitors are superior to diuretics for the long-term prevention of major cardiovascular complications of hypertension.
authors.affiliation: Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Cushman
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.forename: Sara L
authors.initials: SL
authors.lastname: Pressel
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cutler
authors.forename: Paula T
authors.initials: PT
authors.lastname: Einhorn
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ford
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Probstfield
authors.forename: Paul K
authors.initials: PK
authors.lastname: Whelton
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Michael H
authors.initials: MH
authors.lastname: Alderman
authors.forename: Jan N
authors.initials: JN
authors.lastname: Basile
authors.forename: Henry R
authors.initials: HR
authors.lastname: Black
authors.forename: Richard H
authors.initials: RH
authors.lastname: Grimm
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Hamilton
authors.forename: L Julian
authors.initials: LJ
authors.lastname: Haywood
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Ong
authors.forename: Linda B
authors.initials: LB
authors.lastname: Piller
authors.forename: Lara M
authors.initials: LM
authors.lastname: Simpson
authors.forename: Carol
authors.initials: C
authors.lastname: Stanford
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weiss
mesh_terms: D054058:Acute Coronary Syndrome / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D050356:Lipid Metabolism / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010043:Outcome and Process Assessment, Health Care; D011159:Population Surveillance; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States / Q000208:ethnology
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents