Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial

Frans H.H. Leenen, Chuke E. Nwachuku, Henry R. Black, William Cushman, Barry R. Davis, Lara M. Simpson, Michael H. Alderman, Steven A. Atlas, Jan N. Basile, Aloysius B. Cuyjet, Richard Dart, James V. Felicetta, Richard H. Grimm, L. Julian Haywood, Syed Z.A. Jafri, Michael A. Proschan, Udho Thadani, Paul K. Whelton, Jackson T. Wright

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm.

Original languageEnglish (US)
Pages (from-to)374-384
Number of pages11
JournalHypertension
Volume48
Issue number3
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Lisinopril
Calcium Channel Blockers
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Myocardial Infarction
Lipids
Amlodipine
Stroke
Angioedema
Cardiovascular Diseases
Chronic Kidney Failure
Coronary Disease
Therapeutics
Heart Failure
Hemorrhage
Blood Pressure
Mortality
Kidney Neoplasms
Peripheral Arterial Disease
Safety

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. / Leenen, Frans H.H.; Nwachuku, Chuke E.; Black, Henry R.; Cushman, William; Davis, Barry R.; Simpson, Lara M.; Alderman, Michael H.; Atlas, Steven A.; Basile, Jan N.; Cuyjet, Aloysius B.; Dart, Richard; Felicetta, James V.; Grimm, Richard H.; Haywood, L. Julian; Jafri, Syed Z.A.; Proschan, Michael A.; Thadani, Udho; Whelton, Paul K.; Wright, Jackson T.

In: Hypertension, Vol. 48, No. 3, 01.09.2006, p. 374-384.

Research output: Contribution to journalArticle

Leenen, FHH, Nwachuku, CE, Black, HR, Cushman, W, Davis, BR, Simpson, LM, Alderman, MH, Atlas, SA, Basile, JN, Cuyjet, AB, Dart, R, Felicetta, JV, Grimm, RH, Haywood, LJ, Jafri, SZA, Proschan, MA, Thadani, U, Whelton, PK & Wright, JT 2006, 'Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial', Hypertension, vol. 48, no. 3, pp. 374-384. https://doi.org/10.1161/01.HYP.0000231662.77359.de
Leenen, Frans H.H. ; Nwachuku, Chuke E. ; Black, Henry R. ; Cushman, William ; Davis, Barry R. ; Simpson, Lara M. ; Alderman, Michael H. ; Atlas, Steven A. ; Basile, Jan N. ; Cuyjet, Aloysius B. ; Dart, Richard ; Felicetta, James V. ; Grimm, Richard H. ; Haywood, L. Julian ; Jafri, Syed Z.A. ; Proschan, Michael A. ; Thadani, Udho ; Whelton, Paul K. ; Wright, Jackson T. / Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. In: Hypertension. 2006 ; Vol. 48, No. 3. pp. 374-384.
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T1 - Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial

AU - Leenen, Frans H.H.

AU - Nwachuku, Chuke E.

AU - Black, Henry R.

AU - Cushman, William

AU - Davis, Barry R.

AU - Simpson, Lara M.

AU - Alderman, Michael H.

AU - Atlas, Steven A.

AU - Basile, Jan N.

AU - Cuyjet, Aloysius B.

AU - Dart, Richard

AU - Felicetta, James V.

AU - Grimm, Richard H.

AU - Haywood, L. Julian

AU - Jafri, Syed Z.A.

AU - Proschan, Michael A.

AU - Thadani, Udho

AU - Whelton, Paul K.

AU - Wright, Jackson T.

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N2 - The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm.

AB - The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm.

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