Heart failure in ALLHAT: did blood pressure medication at study entry influence outcome?

Abstract

J Clin Hypertens (Greenwich). 2009;11:466-474. (c)2009 Wiley Periodicals, Inc.Lower heart failure (HF) rates in individuals taking chlorthalidone vs amlodipine, lisinopril, or doxazosin were unanticipated in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). HF differences appeared early, leading to questions about the possible influence of pre-enrollment antihypertensive drugs. A post hoc study evaluated hospitalized HF events. During year 1479 individuals had HF, with pre-entry antihypertensive medication data obtained on 301 patients (63%). Case-only analysis examined interactive effects (interaction odds ratio [OR, ratio of ORs]) of previous medication and ALLHAT treatment on HF outcomes, eg, did treatment effect differ by pre-entry antihypertensive class? Among cases, 39%, 37%, 17%, and 47% were taking pre-entry diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, and calcium channel blockers, respectively. Interaction OR for year 1 HF for amlodipine vs chlorthalidone for patients taking vs not taking diuretics pre-entry was 1.08 (95% confidence interval [CI], 0.53-2.21; P=.83); for lisinopril vs chlorthalidone, 1.33 (95% CI, 0.65-2.74; P=.44); and for doxazosin vs chlorthalidone, 1.13 (95% CI, 0.57-2.25; P=.73). Controlling for other pre-entry antihypertensives yielded similar results. There was no significant evidence that pre-entry drug type explained observed hospitalized HF differences by ALLHAT treatment.

• Authors: Richard H Grimm, Barry R Davis, Linda B Piller, Jeffrey A Cutler, Karen L Margolis, Joshua Barzilay, Richard A Dart, James F Graumlich, Robert A Murden, Otelio S Randall, ALLHAT Collaborative Research Group
• Journal: Journal of clinical hypertension (Greenwich, Conn.) (J Clin Hypertens (Greenwich)) Vol. 11 Issue 9 Pg. 466-74 (Sep 2009) ISSN: 1751-7176 [Electronic] United States
• PMID: 19751458 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic alpha-Antagonists
• Antihypertensive Agents
• Doxazosin

Topics

• Adrenergic alpha-Antagonists (therapeutic use)
• Aged
• Antihypertensive Agents (therapeutic use)
• Confidence Intervals
• Double-Blind Method
• Doxazosin (therapeutic use)
• Female
• Heart Failure (etiology, pathology, prevention & control)
• Humans
• Hypertension (complications, drug therapy)
• Male
• Multivariate Analysis
• Odds Ratio
• Risk
• Risk Factors
• Treatment Outcome