How much effect of different antihypertensive medications on cardiovascular outcomes is attributable to their effects on blood pressure?

Michael Proschan, Charles E. Ford, Jeffrey A. Cutler, James F. Graumlich, Valory Pavlik, William Cushman, Barry R. Davis, Michael H. Alderman, David Gordon, Curt D. Furberg, Stanley S. Franklin, Samuel S. Blumenthal, Richard S. Castaldo, Richard A. Preston

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The debate over whether certain antihypertensive medications have benefits beyond what would be expected from their blood pressure lowering spurred the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, which randomized 42,418 participants to chlorthalidone (15,255), amlodipine (9048), lisinopril (9054), or doxazosin (9061). We compared chlorthalidone, the active control, with each of the other three agents with respect to the primary outcome, fatal coronary heart disease or nonfatal myocardial infarction, and several other clinical endpoints. The arms were similar with respect to the primary endpoint, although some differences were found for other endpoints, most notably heart failure. Although the desire was to achieve similar blood pressure reductions in the four arms, we found some systolic blood pressure and diastolic blood pressure differences. A natural question is to what degree can observed treatment group differences in cardiovascular outcomes be attributed to these blood pressure differences. The purpose of this paper was to delineate the problems inherent in attempting to answer this question, and to present analyses intended to overcome these problems.

Original languageEnglish (US)
Pages (from-to)884-897
Number of pages14
JournalStatistics in Medicine
Volume32
Issue number5
DOIs
StatePublished - Feb 28 2013
Externally publishedYes

Fingerprint

Blood Pressure
Antihypertensive Agents
Chlorthalidone
Coronary Heart Disease
Heart Failure
Randomized Trial
Myocardial Infarction
Active Control
Lipids
Doxazosin
Lisinopril
Amlodipine
Fatal Outcome
Attack
Coronary Disease

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Statistics and Probability

Cite this

How much effect of different antihypertensive medications on cardiovascular outcomes is attributable to their effects on blood pressure? / Proschan, Michael; Ford, Charles E.; Cutler, Jeffrey A.; Graumlich, James F.; Pavlik, Valory; Cushman, William; Davis, Barry R.; Alderman, Michael H.; Gordon, David; Furberg, Curt D.; Franklin, Stanley S.; Blumenthal, Samuel S.; Castaldo, Richard S.; Preston, Richard A.

In: Statistics in Medicine, Vol. 32, No. 5, 28.02.2013, p. 884-897.

Research output: Contribution to journalArticle

Proschan, M, Ford, CE, Cutler, JA, Graumlich, JF, Pavlik, V, Cushman, W, Davis, BR, Alderman, MH, Gordon, D, Furberg, CD, Franklin, SS, Blumenthal, SS, Castaldo, RS & Preston, RA 2013, 'How much effect of different antihypertensive medications on cardiovascular outcomes is attributable to their effects on blood pressure?', Statistics in Medicine, vol. 32, no. 5, pp. 884-897. https://doi.org/10.1002/sim.5580
Proschan, Michael ; Ford, Charles E. ; Cutler, Jeffrey A. ; Graumlich, James F. ; Pavlik, Valory ; Cushman, William ; Davis, Barry R. ; Alderman, Michael H. ; Gordon, David ; Furberg, Curt D. ; Franklin, Stanley S. ; Blumenthal, Samuel S. ; Castaldo, Richard S. ; Preston, Richard A. / How much effect of different antihypertensive medications on cardiovascular outcomes is attributable to their effects on blood pressure?. In: Statistics in Medicine. 2013 ; Vol. 32, No. 5. pp. 884-897.
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