1. Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR.
- Author
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Rahman M, Ford CE, Cutler JA, Davis BR, Piller LB, Whelton PK, Wright JT Jr, Barzilay JI, Brown CD, Colon PJ Sr, Fine LJ, Grimm RH Jr, Gupta AK, Baimbridge C, Haywood LJ, Henriquez MA, Ilamaythi E, Oparil S, and Preston R
- Subjects
- Canada, Chronic Disease, Coronary Disease etiology, Coronary Disease mortality, Coronary Disease prevention & control, Double-Blind Method, Female, Heart Failure etiology, Heart Failure mortality, Heart Failure prevention & control, Humans, Hypertension complications, Hypertension mortality, Hypertension physiopathology, Incidence, Kaplan-Meier Estimate, Kidney Diseases complications, Kidney Diseases mortality, Kidney Diseases physiopathology, Kidney Failure, Chronic etiology, Kidney Failure, Chronic mortality, Kidney Failure, Chronic prevention & control, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction etiology, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Proportional Hazards Models, Puerto Rico, Risk Assessment, Risk Factors, Severity of Illness Index, Stroke etiology, Stroke mortality, Stroke prevention & control, Time Factors, Treatment Outcome, United States, United States Virgin Islands, Amlodipine therapeutic use, Antihypertensive Agents therapeutic use, Chlorthalidone therapeutic use, Glomerular Filtration Rate, Hypertension drug therapy, Hypolipidemic Agents therapeutic use, Kidney physiopathology, Kidney Diseases drug therapy, Lisinopril therapeutic use, Myocardial Infarction prevention & control
- Abstract
Background and Objectives: 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., Design, Setting, Participants, & Measurements: 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.
- Published
- 2012
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