Affiliation:
1. From the University of Texas School of Public Health, Houston, TX (L.B.P., S.B., L.M.S., C.E.F., B.R.D.); Memphis Veterans Affairs Medical Center, Memphis, TN (W.C.C.); San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA (B.M.M.); National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.); University of Alabama at Birmingham, Birmingham, AL (S.O.); University of Illinois College of Medicine, Peoria, IL (J.F.G.); Marshfield Clinic Research Foundation,...
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
48 articles.
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