Long-term follow-up of participants with heart failure in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)

Linda B. Piller, Sarah Baraniuk, Lara M. Simpson, William Cushman, Barry M. Massie, Paula T. Einhorn, Suzanne Oparil, Charles E. Ford, James F. Graumlich, Richard A. Dart, David C. Parish, Tamrat M. Retta, Aloysius B. Cuyjet, Syed Z. Jafri, Curt D. Furberg, Mohammad G. Saklayen, Udho Thadani, Jeffrey L. Probstfield, Barry R. Davis

Research output: Contribution to journalArticle

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Abstract

BACKGROUND-: In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in high-risk hypertensive participants, risk of new-onset heart failure (HF) was higher in the amlodipine (2.5-10 mg/d) and lisinopril (10-40 mg/d) arms compared with the chlorthalidone (12.5-25 mg/d) arm. Similar to other studies, mortality rates following new-onset HF were very high (≥ 50% at 5 years), and were similar across randomized treatment arms. After the randomized phase of the trial ended in 2002, outcomes were determined from administrative databases. METHODS AND RESULTS-: With the use of national databases, posttrial follow-up mortality through 2006 was obtained on participants who developed new-onset HF during the randomized (in-trial) phase of ALLHAT. Mean follow-up for the entire period was 8.9 years. Of 1761 participants with incident HF in-trial, 1348 died. Post-HF all-cause mortality was similar across treatment groups, with adjusted hazard ratios (95% confidence intervals) of 0.95 (0.81-1.12) and 1.05 (0.89-1.25), respectively, for amlodipine and lisinopril compared with chlorthalidone, and 10-year adjusted rates of 86%, 87%, and 83%, respectively. All-cause mortality rates were also similar among those with reduced ejection fractions (84%) and preserved ejection fractions (81%), with no significant differences by randomized treatment arm. CONCLUSIONS-: Once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with the development of HF is to be addressed. CLINICAL TRIAL REGISTRATION-: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

Original languageEnglish (US)
Pages (from-to)1811-1818
Number of pages8
JournalCirculation
Volume124
Issue number17
DOIs
StatePublished - Oct 25 2011

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Antihypertensive Agents
Heart Failure
Myocardial Infarction
Lipids
Mortality
Chlorthalidone
Lisinopril
Amlodipine
Databases
Clinical Trials
Confidence Intervals
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Long-term follow-up of participants with heart failure in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). / Piller, Linda B.; Baraniuk, Sarah; Simpson, Lara M.; Cushman, William; Massie, Barry M.; Einhorn, Paula T.; Oparil, Suzanne; Ford, Charles E.; Graumlich, James F.; Dart, Richard A.; Parish, David C.; Retta, Tamrat M.; Cuyjet, Aloysius B.; Jafri, Syed Z.; Furberg, Curt D.; Saklayen, Mohammad G.; Thadani, Udho; Probstfield, Jeffrey L.; Davis, Barry R.

In: Circulation, Vol. 124, No. 17, 25.10.2011, p. 1811-1818.

Research output: Contribution to journalArticle

Piller, LB, Baraniuk, S, Simpson, LM, Cushman, W, Massie, BM, Einhorn, PT, Oparil, S, Ford, CE, Graumlich, JF, Dart, RA, Parish, DC, Retta, TM, Cuyjet, AB, Jafri, SZ, Furberg, CD, Saklayen, MG, Thadani, U, Probstfield, JL & Davis, BR 2011, 'Long-term follow-up of participants with heart failure in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)', Circulation, vol. 124, no. 17, pp. 1811-1818. https://doi.org/10.1161/CIRCULATIONAHA.110.012575
Piller, Linda B. ; Baraniuk, Sarah ; Simpson, Lara M. ; Cushman, William ; Massie, Barry M. ; Einhorn, Paula T. ; Oparil, Suzanne ; Ford, Charles E. ; Graumlich, James F. ; Dart, Richard A. ; Parish, David C. ; Retta, Tamrat M. ; Cuyjet, Aloysius B. ; Jafri, Syed Z. ; Furberg, Curt D. ; Saklayen, Mohammad G. ; Thadani, Udho ; Probstfield, Jeffrey L. ; Davis, Barry R. / Long-term follow-up of participants with heart failure in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). In: Circulation. 2011 ; Vol. 124, No. 17. pp. 1811-1818.
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abstract = "BACKGROUND-: In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in high-risk hypertensive participants, risk of new-onset heart failure (HF) was higher in the amlodipine (2.5-10 mg/d) and lisinopril (10-40 mg/d) arms compared with the chlorthalidone (12.5-25 mg/d) arm. Similar to other studies, mortality rates following new-onset HF were very high (≥ 50{\%} at 5 years), and were similar across randomized treatment arms. After the randomized phase of the trial ended in 2002, outcomes were determined from administrative databases. METHODS AND RESULTS-: With the use of national databases, posttrial follow-up mortality through 2006 was obtained on participants who developed new-onset HF during the randomized (in-trial) phase of ALLHAT. Mean follow-up for the entire period was 8.9 years. Of 1761 participants with incident HF in-trial, 1348 died. Post-HF all-cause mortality was similar across treatment groups, with adjusted hazard ratios (95{\%} confidence intervals) of 0.95 (0.81-1.12) and 1.05 (0.89-1.25), respectively, for amlodipine and lisinopril compared with chlorthalidone, and 10-year adjusted rates of 86{\%}, 87{\%}, and 83{\%}, respectively. All-cause mortality rates were also similar among those with reduced ejection fractions (84{\%}) and preserved ejection fractions (81{\%}), with no significant differences by randomized treatment arm. CONCLUSIONS-: Once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with the development of HF is to be addressed. CLINICAL TRIAL REGISTRATION-: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.",
author = "Piller, {Linda B.} and Sarah Baraniuk and Simpson, {Lara M.} and William Cushman and Massie, {Barry M.} and Einhorn, {Paula T.} and Suzanne Oparil and Ford, {Charles E.} and Graumlich, {James F.} and Dart, {Richard A.} and Parish, {David C.} and Retta, {Tamrat M.} and Cuyjet, {Aloysius B.} and Jafri, {Syed Z.} and Furberg, {Curt D.} and Saklayen, {Mohammad G.} and Udho Thadani and Probstfield, {Jeffrey L.} and Davis, {Barry R.}",
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T1 - Long-term follow-up of participants with heart failure in the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT)

AU - Piller, Linda B.

AU - Baraniuk, Sarah

AU - Simpson, Lara M.

AU - Cushman, William

AU - Massie, Barry M.

AU - Einhorn, Paula T.

AU - Oparil, Suzanne

AU - Ford, Charles E.

AU - Graumlich, James F.

AU - Dart, Richard A.

AU - Parish, David C.

AU - Retta, Tamrat M.

AU - Cuyjet, Aloysius B.

AU - Jafri, Syed Z.

AU - Furberg, Curt D.

AU - Saklayen, Mohammad G.

AU - Thadani, Udho

AU - Probstfield, Jeffrey L.

AU - Davis, Barry R.

PY - 2011/10/25

Y1 - 2011/10/25

N2 - BACKGROUND-: In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in high-risk hypertensive participants, risk of new-onset heart failure (HF) was higher in the amlodipine (2.5-10 mg/d) and lisinopril (10-40 mg/d) arms compared with the chlorthalidone (12.5-25 mg/d) arm. Similar to other studies, mortality rates following new-onset HF were very high (≥ 50% at 5 years), and were similar across randomized treatment arms. After the randomized phase of the trial ended in 2002, outcomes were determined from administrative databases. METHODS AND RESULTS-: With the use of national databases, posttrial follow-up mortality through 2006 was obtained on participants who developed new-onset HF during the randomized (in-trial) phase of ALLHAT. Mean follow-up for the entire period was 8.9 years. Of 1761 participants with incident HF in-trial, 1348 died. Post-HF all-cause mortality was similar across treatment groups, with adjusted hazard ratios (95% confidence intervals) of 0.95 (0.81-1.12) and 1.05 (0.89-1.25), respectively, for amlodipine and lisinopril compared with chlorthalidone, and 10-year adjusted rates of 86%, 87%, and 83%, respectively. All-cause mortality rates were also similar among those with reduced ejection fractions (84%) and preserved ejection fractions (81%), with no significant differences by randomized treatment arm. CONCLUSIONS-: Once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with the development of HF is to be addressed. CLINICAL TRIAL REGISTRATION-: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

AB - BACKGROUND-: In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in high-risk hypertensive participants, risk of new-onset heart failure (HF) was higher in the amlodipine (2.5-10 mg/d) and lisinopril (10-40 mg/d) arms compared with the chlorthalidone (12.5-25 mg/d) arm. Similar to other studies, mortality rates following new-onset HF were very high (≥ 50% at 5 years), and were similar across randomized treatment arms. After the randomized phase of the trial ended in 2002, outcomes were determined from administrative databases. METHODS AND RESULTS-: With the use of national databases, posttrial follow-up mortality through 2006 was obtained on participants who developed new-onset HF during the randomized (in-trial) phase of ALLHAT. Mean follow-up for the entire period was 8.9 years. Of 1761 participants with incident HF in-trial, 1348 died. Post-HF all-cause mortality was similar across treatment groups, with adjusted hazard ratios (95% confidence intervals) of 0.95 (0.81-1.12) and 1.05 (0.89-1.25), respectively, for amlodipine and lisinopril compared with chlorthalidone, and 10-year adjusted rates of 86%, 87%, and 83%, respectively. All-cause mortality rates were also similar among those with reduced ejection fractions (84%) and preserved ejection fractions (81%), with no significant differences by randomized treatment arm. CONCLUSIONS-: Once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with the development of HF is to be addressed. CLINICAL TRIAL REGISTRATION-: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

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