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

Richard H Grimm1, Barry R Davis, Linda B Piller

  • 1Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.

Journal of Clinical Hypertension (Greenwich, Conn.)
|September 16, 2009
PubMed

Insights

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found lower heart failure (HF) rates with chlorthalidone. This study found no significant evidence that prior antihypertensive drug use explained these HF differences.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Pharmacology

Background:

  • The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) unexpectedly showed lower heart failure (HF) rates in patients taking chlorthalidone compared to amlodipine, lisinopril, or doxazosin.
  • Early HF differences in ALLHAT raised questions about the potential impact of antihypertensive medications used before enrollment.

Purpose of the Study:

  • To investigate whether pre-enrollment antihypertensive drug use influenced the observed differences in hospitalized heart failure (HF) events between treatment groups in the ALLHAT study.

Main Methods:

  • A post hoc analysis of hospitalized HF events from the ALLHAT trial was conducted.
  • Pre-enrollment antihypertensive medication data was collected for a subset of patients (63%).
  • A case-only analysis examined the interaction between previous medication classes and ALLHAT treatment on HF outcomes using interaction odds ratios (ORs).

Main Results:

  • Among patients with HF, a significant proportion had prior use of diuretics (39%), angiotensin-converting enzyme inhibitors (37%), beta-blockers (17%), and calcium channel blockers (47%).
  • Interaction ORs for year 1 HF comparing amlodipine, lisinopril, or doxazosin to chlorthalidone, stratified by pre-entry diuretic use, were not statistically significant (e.g., amlodipine vs. chlorthalidone: 1.08, P=.83).
  • Similar non-significant results were observed when controlling for other pre-entry antihypertensive classes.

Conclusions:

  • There was no significant evidence found to suggest that the type of antihypertensive medication used prior to the ALLHAT trial explained the observed differences in hospitalized heart failure rates between the treatment groups.

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