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Long-term follow-up of participants with heart failure in the antihypertensive and lipid-lowering treatment to
Linda B Piller1, Sarah Baraniuk, Lara M Simpson
1University of Texas School of Public Health, Houston, TX 77030, USA. Linda.B.Piller@uth.tmc.edu
Circulation
|October 5, 2011
Summary
New-onset heart failure (HF) risk was higher with amlodipine and lisinopril versus chlorthalidone in the ALLHAT trial. However, mortality after developing HF was similar across all treatment groups, emphasizing prevention.
Area of Science:
- Cardiology
- Clinical Trials
- Hypertension Management
Background:
- The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) identified increased risk of new-onset heart failure (HF) with amlodipine and lisinopril compared to chlorthalidone.
- Mortality rates following new-onset HF were high (≥50% at 5 years) and consistent across randomized treatment arms in ALLHAT.
Purpose of the Study:
- To analyze post-trial mortality in participants who developed new-onset heart failure (HF) during the ALLHAT randomized phase.
- To compare all-cause mortality rates following HF development across different antihypertensive treatment groups.
Main Methods:
- Utilized national administrative databases for post-trial mortality follow-up through 2006.
- Analyzed data from 1761 participants who developed incident HF during the ALLHAT trial.
- Calculated adjusted hazard ratios and 10-year mortality rates for amlodipine and lisinopril versus chlorthalidone.
Main Results:
- Post-HF all-cause mortality was similar across treatment groups: amlodipine (HR 0.95), lisinopril (HR 1.05) compared to chlorthalidone.
- Estimated 10-year adjusted mortality rates were 86% (amlodipine), 87% (lisinopril), and 83% (chlorthalidone).
- Mortality rates were similar for participants with reduced (84%) and preserved (81%) ejection fractions, irrespective of treatment arm.
Conclusions:
- Once heart failure develops, the risk of death is substantial and uniform across randomized treatment groups.
- Prioritizing HF prevention, particularly through effective blood pressure control, is crucial for reducing mortality associated with HF development.
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