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Published on: July 3, 2013

Does ALLHAT change the management of hypertension in chronic kidney disease?

Martin MacKinnon1, Frans H H Leenen, Marcel Ruzicka

  • 1Division of Nephrology and Kidney Research Centre, The Ottawa Hospital-Riverside Campus, Room 5-21, 1967 Riverside Drive, Ottawa, Ontario, Canada, K1H 7W9.

Current Hypertension Reports
|January 3, 2006
PubMed

Insights

The Antihypertensive and Lipid-Lowering Treatment Trial to Prevent Heart Attack (ALLHAT) found no significant differences in end-stage renal disease (ESRD) rates among chlorthalidone, amlodipine, or lisinopril. Blood pressure control is key for this patient group.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • The Antihypertensive and Lipid-Lowering Treatment Trial to Prevent Heart Attack (ALLHAT) investigated newer antihypertensive agents against thiazide diuretics.
  • Secondary outcomes included end-stage renal disease (ESRD) and estimated glomerular filtration rate (GFR) decline.

Purpose of the Study:

  • To compare cardiovascular outcomes of newer antihypertensive drugs versus a thiazide diuretic.
  • To assess the impact of different antihypertensive treatments on renal outcomes.

Main Methods:

  • Randomized controlled trial comparing chlorthalidone, amlodipine, and lisinopril.
  • Follow-up for cardiovascular and renal outcomes over 5-6 years.

Main Results:

  • No significant differences in overall ESRD rates were observed between the treatment groups.
  • A slower GFR decline was noted with amlodipine in both diabetic and non-diabetic participants.
  • The composite endpoint of ESRD or a 50% GFR decline was reduced in non-diabetics on amlodipine.

Conclusions:

  • For patients with systolic BP > 130 mm Hg, initiating treatment with a thiazide diuretic, calcium channel blocker, or ACE inhibitor shows no difference in renal outcomes over 5-6 years.
  • Blood pressure control itself is the primary objective for managing renal outcomes in this population.

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