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Stroke outcomes among participants randomized to chlorthalidone, amlodipine or lisinopril in ALLHAT

José-Miguel Yamal1, Suzanne Oparil2, Barry R Davis1

  • 1Coordinating Center for Clinical Trials, Division of Biostatistics, University of Texas School of Public Health, Houston, TX, USA.

Journal of the American Society of Hypertension : JASH
|December 3, 2014
PubMed

Insights

The ALLHAT trial found lisinopril was less effective for stroke prevention in Black individuals and women compared to other drugs initially. However, these differences in stroke rates disappeared over the long term.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Trials
  • Pharmacology

Background:

  • Hypertension management is crucial for preventing cardiovascular events.
  • The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) evaluated major antihypertensive drug classes.
  • Stroke is a significant complication of hypertension.

Purpose of the Study:

  • To compare stroke outcomes among participants treated with different initial antihypertensive medications.
  • To investigate potential differences in stroke prevention efficacy based on race and gender.

Main Methods:

  • A large-scale, randomized, double-blind, active-controlled trial involving 33,357 high-risk hypertensive participants.
  • Comparison of cardiovascular disease outcomes, specifically stroke, with initial treatment of lisinopril, amlodipine, or chlorthalidone.
  • Extended follow-up including in-trial and post-trial surveillance for a total of 8-13 years.

Main Results:

  • Initially, stroke rates were higher with lisinopril compared to chlorthalidone or amlodipine, particularly in Black individuals and women.
  • These in-trial differences were influenced by race and gender interactions.
  • Over the 10-year follow-up period, no significant overall treatment differences in stroke rates were detected across groups.
  • No treatment differences were observed in all-cause mortality, even for participants with nonfatal strokes.

Conclusions:

  • While initial stroke prevention efficacy varied by race and gender for lisinopril, these disparities diminished over the extended follow-up period.
  • No long-term differences in stroke incidence or mortality were found among the compared antihypertensive treatments.
  • The findings underscore the importance of long-term follow-up in comparative effectiveness trials.

Keywords:
ACE inhibitorcalcium channel blockerdiuretichypertension

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