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Treatment-Resistant Hypertension and Outcomes Based on Randomized Treatment Group in ALLHAT
Sripal Bangalore1, Barry R Davis2, William C Cushman3
1Department of Medicine, New York University School of Medicine.
The American Journal of Medicine
|December 17, 2016
Summary
Treatment-resistant hypertension prognosis was similar across groups, though chlorthalidone use was linked to lower incidence. This study analyzed outcomes in patients with uncontrolled high blood pressure.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Hypertension guidelines define treatment-resistant hypertension (TRH) as uncontrolled blood pressure despite ≥3 medications, including a diuretic.
- The prognostic impact of diuretic inclusion in TRH management remains unclear.
Purpose of the Study:
- To investigate the prevalence of apparent treatment-resistant hypertension (aTRH) in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
- To compare the association of aTRH with cardiovascular outcomes across different first-step antihypertensive therapies.
Main Methods:
- ALLHAT participants were randomized to chlorthalidone, amlodipine, or lisinopril.
- aTRH was defined at Year 2 follow-up based on blood pressure and medication count (≥3 medications with BP ≥140/90 mmHg, or ≥4 medications with BP <140/90 mmHg).
- Primary (fatal coronary heart disease or nonfatal myocardial infarction) and secondary (all-cause mortality, stroke, heart failure, etc.) outcomes were analyzed.
Main Results:
- Prevalence of aTRH was 9.6% with chlorthalidone, 11.4% with amlodipine, and 19.7% with lisinopril.
- Primary outcome incidence was similar across treatment groups during 2.9 years of follow-up.
- Secondary outcome risks were similar, except for higher coronary revascularization with amlodipine vs. chlorthalidone.
Conclusions:
- Participants assigned to chlorthalidone were less likely to develop treatment-resistant hypertension.
- Prognoses for patients with treatment-resistant hypertension were similar across the chlorthalidone, amlodipine, and lisinopril groups.
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