title: Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR.
abstract: OBJECTIVE
  CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with chlorthalidone.
  
  
  METHODS
  This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged ≥55 years, randomized to receive chlorthalidone, amlodipine, or lisinopril for 4-8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m(2)) as follows: normal/increased (≥90; n=8027), mild reduction (60-89; n=17,778), and moderate/severe reduction (<60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD.
  
  
  RESULTS
  After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P<0.001). In participants with an eGFR <60, there was no significant difference in cardiovascular mortality between chlorthalidone and amlodipine (P=0.64), or chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD.
  
  
  CONCLUSIONS
  CKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up. Because data on proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.
authors.affiliation: Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Case Medical Center, USA.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ford
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cutler
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.forename: Linda B
authors.initials: LB
authors.lastname: Piller
authors.forename: Paul K
authors.initials: PK
authors.lastname: Whelton
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Barzilay
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Brown
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Colon
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Fine
authors.forename: Richard H
authors.initials: RH
authors.lastname: Grimm
authors.forename: Alok K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Charles
authors.initials: C
authors.lastname: Baimbridge
authors.forename: L Julian
authors.initials: LJ
authors.lastname: Haywood
authors.forename: Mario A
authors.initials: MA
authors.lastname: Henriquez
authors.forename: Ekambaram
authors.initials: E
authors.lastname: Ilamaythi
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Richard
authors.initials: R
authors.lastname: Preston
mesh_terms: D017311:Amlodipine / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002170:Canada; D002752:Chlorthalidone / Q000627:therapeutic use*; D002908:Chronic Disease; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D017706:Lisinopril / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011647:Puerto Rico; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014767:United States Virgin Islands
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D017311:Amlodipine; D017706:Lisinopril; D002752:Chlorthalidone