Long-Term renal and cardiovascular outcomes in antihypertensive and Lipid-Lowering treatment to prevent heart attack trial (ALLHAT) participants by baseline estimated GFR

Mahboob Rahman, Charles E. Ford, Jeffrey A. Cutler, Barry R. Davis, Linda B. Piller, Paul K. Whelton, Jackson T. Wright, Joshua I. Barzilay, Clinton D. Brown, Pedro J. Colon, Lawrence J. Fine, Richard H. Grimm, Alok K. Gupta, Charles Baimbridge, L. Julian Haywood, Mario A. Henriquez, Ekambaram Ilamaythi, Suzanne Oparil, Richard Preston

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)989-1002
Number of pages14
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number6
DOIs
StatePublished - Jun 1 2012
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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