title: Long-term follow-up of moderately hypercholesterolemic hypertensive patients following randomization to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT).
abstract: The authors conducted a randomized, controlled, multicenter trial, in which they assigned well-controlled hypertensive participants aged 55 years and older with moderate hypercholesterolemia to receive pravastatin (n=5170) or usual care (n=5185) for 4 to 8 years, when trial therapy was discontinued. Passive surveillance using national databases to ascertain deaths and hospitalizations continued for a total follow-up of 8 to 13 years to assess whether mortality and morbidity differences persisted or new differences developed. During the post-trial period, fatal and nonfatal outcomes were available for 98% and 64% of participants, respectively. The primary outcome was all-cause mortality and the secondary outcomes included cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, cardiovascular disease, and end-stage renal disease. No significant differences appeared in mortality for pravastatin vs usual care (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.89-1.03) or other secondary outcomes. Similar to the previously reported in-trial result, there was a significant treatment effect for CHD in black patients (HR, 0.79; 95% CI, 0.64-0.98). However, the in-trial result showing a significant treatment by race effect did not remain significant during the entire follow-up (P=.08). These findings are consistent with evidence from other large trials that show statins prevent CHD and add evidence that they are effective for CHD prevention in black patients.
authors.affiliation: Health Partners Institute for Education and Research, Minneapolis, MN, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.forename: Charles
authors.initials: C
authors.lastname: Baimbridge
authors.forename: Jerry O
authors.initials: JO
authors.lastname: Ciocon
authors.forename: Aloysius B
authors.initials: AB
authors.lastname: Cuyjet
authors.forename: Richard A
authors.initials: RA
authors.lastname: Dart
authors.forename: Paula T
authors.initials: PT
authors.lastname: Einhorn
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ford
authors.forename: David
authors.initials: D
authors.lastname: Gordon
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hartney
authors.forename: L
authors.initials: L
authors.lastname: Julian Haywood
authors.forename: Jordan
authors.initials: J
authors.lastname: Holtzman
authors.forename: David E
authors.initials: DE
authors.lastname: Mathis
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Probstfield
authors.forename: Lara M
authors.initials: LM
authors.lastname: Simpson
authors.forename: John D
authors.initials: JD
authors.lastname: Stokes
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Wiegmann
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D044383:Black People; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017035:Pravastatin / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin
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