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Barry R. Davis - One of the best experts on this subject based on the ideXlab platform.

  • the effects of antihypertensive class on gout in older adults secondary analysis of the antihypertensive and lipid lowering treatment to prevent heart attack trial
    Journal of Hypertension, 2020
    Co-Authors: Stephen P Juraschek, Barry R. Davis, Lara M Simpson, Robert H Shmerling, Jennifer Beach, Anthony Ishak, Kenneth J Mukamal
    Abstract:

    OBJECTIVES Gout is a common complication of blood pressure management and a frequently cited cause of medication nonadherence. Little trial evidence exists to inform antihypertensive selection with regard to gout risk. METHODS The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized clinical trial on the effects of first-step hypertension therapy with amlodipine, Chlorthalidone, or lisinopril on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). Trial participants were linked to CMS and VA gout claims (ICD9 274.XX). We determined the effect of drug assignment on gout with Cox regression models. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) with gout. RESULTS Claims were linked to 23 964 participants (mean age 69.8 ± 6.8 years, 45% women, 31% black). Atenolol use was reported by 928 participants at the 1-month visit. Over a mean follow-up of 4.9 years, we documented 597 gout claims. Amlodipine reduced the risk of gout by 37% (hazard ratio 0.63; 95% CI 0.51--0.78) compared with Chlorthalidone and by 26% (hazard ratio 0.74; 95% CI 0.58--0.94) compared with lisinopril. Lisinopril nonsignificantly lowered gout risk compared with Chlorthalidone (hazard ratio 0.85; 95% CI 0.70--1.03). Atenolol use was not associated with gout risk (adjusted hazard ratio 1.18; 95% CI 0.78--1.80). Gout risk reduction was primarily observed after 1 year of follow-up. CONCLUSION Amlodipine lowered long-term gout risk compared with lisinopril or Chlorthalidone. This finding may be useful in cases where gout risk is a principal concern among patients being treated for hypertension.This trial is registered at clinicaltrials.gov, number: NCT00000542.

  • pharmacologic prevention of incident atrial fibrillation long term results from the allhat antihypertensive and lipid lowering treatment to prevent heart attack trial
    Circulation-arrhythmia and Electrophysiology, 2017
    Co-Authors: Thomas A Dewland, Barry R. Davis, Lara M Simpson, Julian L Haywood, Elsayed Z Soliman, Josemiguel Yamal, Alvaro Alonso, Christine M Albert, Gregory M Marcus
    Abstract:

    Background Although atrial fibrillation (AF) guidelines indicate that pharmacological blockade of the renin–angiotensin system may be considered for primary AF prevention in hypertensive patients, previous studies have yielded conflicting results. We sought to determine whether randomization to lisinopril reduces incident AF or atrial flutter (AFL) compared with Chlorthalidone in a large clinical trial cohort with extended post-trial surveillance. Methods and Results We performed a secondary analysis of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), a randomized, double-blind, active-controlled clinical trial that enrolled hypertensive individuals ≥55 years of age with at least one other cardiovascular risk factor. Participants were randomly assigned to receive amlodipine, lisinopril, or Chlorthalidone. Individuals with elevated fasting low-density lipoprotein cholesterol levels were also randomized to pravastatin versus usual care. The primary outcome was the development of either AF or AFL as diagnosed by serial study ECGs or by Medicare claims data. Among 14 837 participants without prevalent AF or AFL, 2514 developed AF/AFL during a mean 7.5±3.2 years of follow-up. Compared with Chlorthalidone, randomization to either lisinopril (hazard ratio, 1.04; 95% confidence interval, 0.94–1.15; P =0.46) or amlodipine (hazard ratio, 0.93; 95% confidence interval, 0.84–1.03; P =0.16) was not associated with a significant reduction in incident AF/AFL. Conclusions Compared with Chlorthalidone, treatment with lisinopril is not associated with a meaningful reduction in incident AF or AFL among older adults with a history of hypertension. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.

  • influence of prevalent and incident atrial fibrillation on post trial major events in allhat
    Journal of The National Medical Association, 2017
    Co-Authors: Julian L Haywood, Barry R. Davis, William C. Cushman, Jeffrey A. Cutler, Lara M Simpson, Charles E Ford, Linda B Piller, Alokananda Ghosh, Elsayed Z Soliman, Jackson T. Wright
    Abstract:

    Abstract Aims Limited information is available on long-term antihypertensive and lipid-lowering therapy effects on hypertensive patients with atrial fibrillation/flutter (AF/AFL) compared to those without. AF/AFL at baseline or during the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (mean follow-up 4.9 years) markedly increased risk of stroke, heart failure, CHD, and all-cause mortality. We aimed to determine if AF/AFL continued to impact outcomes during post-trial follow-up (mean 3.8 years). Methods Patients were randomized to Chlorthalidone, amlodipine, or lisinopril, and to pravastatin vs. usual care in the lipid-lowering trial (LLT). Of 31,473 available subjects, AF/AFL occurred in 854; 383/14,371 Chlorthalidone (2.7%), 247/8565 amlodipine (2.9%), and 224/8537 lisinopril (2.6%). Post-hoc analyses utilized administrative databases for post-trial data. Individuals with AF/AFL were compared to those without during post-trial. Outcomes were analyzed by treatment groups for the antihypertensive and LLT trials. Results Among 854 AF/AFL participants, 491 (57.5%) died: 220 in-trial, 271 post-trial. Ten-year all-cause mortality rates for those with in-trial AF/AFL were similar for Chlorthalidone and lisinopril, but lower for amlodipine (68, 66, and 49 per 100 persons, respectively); adjusted HR for amlodipine vs. Chlorthalidone was 0.68 (95% CI, 0.54–0.87). Ten-year all-cause mortality rates were 57 vs. 65 per 100 persons (pravastatin vs. usual care); non-CVD mortality rates, 18 vs. 39 per 100 persons (pravastatin vs. usual care) (adjusted HR = 0.46, 95% CI, 0.24–0.86). Conclusion Post-trial follow-up revealed continued deleterious AF/AFL effects. The amlodipine (ALLHAT) and pravastatin (ALLHAT-LLT) treatment groups showed lower all-cause and non-CVD mortality compared to the Chlorthalidone and usual-care groups, respectively.

  • should antihypertensive treatment recommendations differ in patients with and without coronary heart disease from the antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    American Journal of Cardiology, 2016
    Co-Authors: Michael H Alderman, Sara L Pressel, Barry R. Davis, Charles E Ford, Julian L Haywood, Linda B Piller, Paula T Einhorn, Sarah M Baraniuk, Mahshid Assadi, Ekambaram Ilamathi
    Abstract:

    Thiazide-type diuretics have been recommended for initial treatment of hypertension in most patients, but should this recommendation differ for patients with and without coronary heart disease (CHD)? The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind hypertension treatment trial in 42,418 participants with high risk of combined cardiovascular disease (CVD) (25% with preexisting CHD). This post hoc analysis compares long-term major clinical outcomes in those assigned amlodipine (n = 9048) or lisinopril (n = 9,054) with those assigned Chlorthalidone (n = 15,255), stratified by CHD status. After 4 to 8 years, randomized treatment was discontinued. Total follow-up (active treatment + passive surveillance using national databases for deaths and hospitalizations) was 8 to 13 years. For most CVD outcomes, end-stage renal disease, and total mortality, there were no differences across randomized treatment arms regardless of baseline CHD status. In-trial rates of CVD were significantly higher for lisinopril compared with Chlorthalidone, and rates of heart failure were significantly higher for amlodipine compared with Chlorthalidone in those with and without CHD (overall hazard ratios [HRs] 1.10, p

  • stroke outcomes among participants randomized to Chlorthalidone amlodipine or lisinopril in allhat
    Journal of The American Society of Hypertension, 2014
    Co-Authors: Josemiguel Yamal, Barry R. Davis, William C. Cushman, Suzanne Oparil, Michael H Alderman, David A Calhoun, Herbert F Fendley, Stanley S Franklin, Gabriel B Habib, Sara L Pressel
    Abstract:

    The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in 33,357 high-risk hypertensive participants. ALLHAT compared cardiovascular disease outcomes in participants initially treated with an angiotensin-converting enzyme inhibitor (lisinopril), a calcium channel blocker (amlodipine), or a thiazide-type diuretic (Chlorthalidone). We report stroke outcomes in 1517 participants in-trial and 1596 additional participants during post-trial passive surveillance, for a total follow-up of 8-13 years. Stroke rates were higher with lisinopril (6-year rate/100 = 6.4) than with Chlorthalidone (5.8) or amlodipine (5.5) in-trial but not including post-trial (10-year rates/100 = 13.2 [Chlorthalidone], 13.1[amlodipine], and 13.7 [lisinopril]). In-trial differences were driven by race (race-by-lisinopril/Chlorthalidone interaction P = .005, race-by-amlodipine/lisinopril interaction P = .012) and gender (gender-by-lisinopril/amlodipine interaction P = .041), separately. No treatment differences overall, or by race or gender, were detected over the 10-year period. No differences appeared among treatment groups in adjusted risk of all-cause mortality including post-trial for participants with nonfatal in-trial strokes. Among Blacks and women, lisinopril was less effective in preventing stroke in-trial than either Chlorthalidone or amlodipine, even after adjusting for differences in systolic blood pressure. These differences abated by the end of the post-trial period.

William C. Cushman - One of the best experts on this subject based on the ideXlab platform.

  • influence of prevalent and incident atrial fibrillation on post trial major events in allhat
    Journal of The National Medical Association, 2017
    Co-Authors: Julian L Haywood, Barry R. Davis, William C. Cushman, Jeffrey A. Cutler, Lara M Simpson, Charles E Ford, Linda B Piller, Alokananda Ghosh, Elsayed Z Soliman, Jackson T. Wright
    Abstract:

    Abstract Aims Limited information is available on long-term antihypertensive and lipid-lowering therapy effects on hypertensive patients with atrial fibrillation/flutter (AF/AFL) compared to those without. AF/AFL at baseline or during the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (mean follow-up 4.9 years) markedly increased risk of stroke, heart failure, CHD, and all-cause mortality. We aimed to determine if AF/AFL continued to impact outcomes during post-trial follow-up (mean 3.8 years). Methods Patients were randomized to Chlorthalidone, amlodipine, or lisinopril, and to pravastatin vs. usual care in the lipid-lowering trial (LLT). Of 31,473 available subjects, AF/AFL occurred in 854; 383/14,371 Chlorthalidone (2.7%), 247/8565 amlodipine (2.9%), and 224/8537 lisinopril (2.6%). Post-hoc analyses utilized administrative databases for post-trial data. Individuals with AF/AFL were compared to those without during post-trial. Outcomes were analyzed by treatment groups for the antihypertensive and LLT trials. Results Among 854 AF/AFL participants, 491 (57.5%) died: 220 in-trial, 271 post-trial. Ten-year all-cause mortality rates for those with in-trial AF/AFL were similar for Chlorthalidone and lisinopril, but lower for amlodipine (68, 66, and 49 per 100 persons, respectively); adjusted HR for amlodipine vs. Chlorthalidone was 0.68 (95% CI, 0.54–0.87). Ten-year all-cause mortality rates were 57 vs. 65 per 100 persons (pravastatin vs. usual care); non-CVD mortality rates, 18 vs. 39 per 100 persons (pravastatin vs. usual care) (adjusted HR = 0.46, 95% CI, 0.24–0.86). Conclusion Post-trial follow-up revealed continued deleterious AF/AFL effects. The amlodipine (ALLHAT) and pravastatin (ALLHAT-LLT) treatment groups showed lower all-cause and non-CVD mortality compared to the Chlorthalidone and usual-care groups, respectively.

  • Chlorthalidone versus hydrochlorothiazide a new kind of veterans affairs cooperative study
    Annals of Internal Medicine, 2016
    Co-Authors: Frank A Lederle, William C. Cushman, Ryan Ferguson, Mary Brophy, Louis D Fiore
    Abstract:

    This article is an overview of a large, multicenter, randomized clinical trial that will compare the effects of hydrochlorothiazide with Chlorthalidone on cardiovascular events among Veterans Affai...

  • stroke outcomes among participants randomized to Chlorthalidone amlodipine or lisinopril in allhat
    Journal of The American Society of Hypertension, 2014
    Co-Authors: Josemiguel Yamal, Barry R. Davis, William C. Cushman, Suzanne Oparil, Michael H Alderman, David A Calhoun, Herbert F Fendley, Stanley S Franklin, Gabriel B Habib, Sara L Pressel
    Abstract:

    The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in 33,357 high-risk hypertensive participants. ALLHAT compared cardiovascular disease outcomes in participants initially treated with an angiotensin-converting enzyme inhibitor (lisinopril), a calcium channel blocker (amlodipine), or a thiazide-type diuretic (Chlorthalidone). We report stroke outcomes in 1517 participants in-trial and 1596 additional participants during post-trial passive surveillance, for a total follow-up of 8-13 years. Stroke rates were higher with lisinopril (6-year rate/100 = 6.4) than with Chlorthalidone (5.8) or amlodipine (5.5) in-trial but not including post-trial (10-year rates/100 = 13.2 [Chlorthalidone], 13.1[amlodipine], and 13.7 [lisinopril]). In-trial differences were driven by race (race-by-lisinopril/Chlorthalidone interaction P = .005, race-by-amlodipine/lisinopril interaction P = .012) and gender (gender-by-lisinopril/amlodipine interaction P = .041), separately. No treatment differences overall, or by race or gender, were detected over the 10-year period. No differences appeared among treatment groups in adjusted risk of all-cause mortality including post-trial for participants with nonfatal in-trial strokes. Among Blacks and women, lisinopril was less effective in preventing stroke in-trial than either Chlorthalidone or amlodipine, even after adjusting for differences in systolic blood pressure. These differences abated by the end of the post-trial period.

  • mortality and morbidity during and after antihypertensive and lipid lowering treatment to prevent heart attack trial results by sex
    Hypertension, 2013
    Co-Authors: Suzanne Oparil, Barry R. Davis, William C. Cushman, Curt D. Furberg, Charles E Ford, Julian L Haywood, Gabriel B Habib, Jeffrey L Probstfield, Karen L Margolis, Paul K. Whelton
    Abstract:

    To determine whether an angiotensin-converting enzyme inhibitor (lisinopril) or calcium channel blocker (amlodipine) is superior to a diuretic (Chlorthalidone) in reducing cardiovascular disease incidence in sex subgroups, we carried out a prespecified subgroup analysis of 15 638 women and 17 719 men in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Total follow-up (active treatment + passive surveillance using national administrative databases to ascertain deaths and hospitalizations) was 8 to 13 years. The primary outcome was fatal coronary heart disease or nonfatal myocardial infarction. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (coronary heart disease death, nonfatal myocardial infarction, stroke, angina, coronary revascularization, heart failure [HF], or peripheral vascular disease), and end-stage renal disease. In-trial rates of HF, stroke, and combined cardiovascular disease were significantly higher for lisinopril compared with Chlorthalidone, and rates of HF were significantly higher for amlodipine compared with Chlorthalidone in both men and women. There were no significant treatment sex interactions. These findings did not persist through the extension period with the exception of the HF result for amlodipine versus Chlorthalidone, which did not differ significantly by sex. For both women and men, rates were not lower in the amlodipine or lisinopril groups than in the Chlorthalidone group for either the primary coronary heart disease outcome or any other cardiovascular disease outcome, and Chlorthalidone-based treatment resulted in the lowest risk of HF. Neither lisinopril nor amlodipine is superior to Chlorthalidone for initial treatment of hypertension in either women or men. Clinical Trial Registration- clinicaltrials.gov; Identifier: NCT00000542.

  • azilsartan medoxomil plus Chlorthalidone reduces blood pressure more effectively than olmesartan plus hydrochlorothiazide in stage 2 systolic hypertension
    Hypertension, 2012
    Co-Authors: William C. Cushman, George L Bakris, William B. White, Domenic A Sica, Michael Weber, A V Roberts, Eric E Lloyd, Stuart Kupfer
    Abstract:

    Azilsartan medoxomil, an effective, long-acting angiotensin II receptor blocker, is a new treatment for hypertension that is also being developed in fixed-dose combinations with Chlorthalidone, a potent, long-acting thiazide-like diuretic. We compared once-daily fixed-dose combinations of azilsartan medoxomil/Chlorthalidone force titrated to a high dose of either 40/25 mg or 80/25 mg with a fixed-dose combination of the angiotensin II receptor blocker olmesartan medoxomil plus the thiazide diuretic hydrochlorothiazide force titrated to 40/25 mg. The design was a randomized, 3-arm, double-blind, 12-week study of 1071 participants with baseline clinic systolic blood pressure 160 to 190 mm Hg and diastolic blood pressure ≤119 mm Hg. Patients had a mean age of 57 years; 59% were men, 73% were white, and 22% were black. At baseline, mean clinic blood pressure was 165/96 mm Hg and 24-hour mean blood pressure was 150/88 mm Hg. Changes in clinic (primary end point) and ambulatory systolic blood pressures at week 12 were significantly greater in both azilsartan medoxomil/Chlorthalidone arms than in the olmesartan/hydrochlorothiazide arm ( P

Paul K. Whelton - One of the best experts on this subject based on the ideXlab platform.

  • effect of Chlorthalidone amlodipine and lisinopril on visit to visit variability of blood pressure results from the antihypertensive and lipid lowering treatment to prevent heart attack trial
    Journal of Clinical Hypertension, 2014
    Co-Authors: Paul Muntner, Barry R. Davis, Paul K. Whelton, Emily B Levitan, Amy I Lynch, Lara M Simpson, Jeff Whittle, John B Kostis, Suzanne Oparil
    Abstract:

    Few randomized trials have compared visit-to-visit variability (VVV) of systolic blood pressure (SBP) across drug classes. The authors compared VVV of SBP among 24,004 participants randomized to Chlorthalidone, amlodipine, or lisinopril in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). VVV of SBP was calculated across 5 to 7 visits occurring 6 to 28 months following randomization. The standard deviation (SD) of SBP was 10.6 (SD=5.0), 10.5 (SD=4.9), and 12.2 (SD=5.8) for participants randomized to Chlorthalidone, amlodipine, and lisinopril, respectively. After multivariable adjustment including mean SBP across visits and compared with participants randomized to Chlorthalidone, participants randomized to amlodipine had a 0.36 (standard error [SE]: 0.07) lower SD of SBP and participants randomized to lisinopril had a 0.77 (SE=0.08) higher SD of SBP. Results were consistent using other VVV of SBP metrics. These data suggest Chlorthalidone and amlodipine are associated with lower VVV of SBP than lisinopril.

  • mortality and morbidity during and after antihypertensive and lipid lowering treatment to prevent heart attack trial results by sex
    Hypertension, 2013
    Co-Authors: Suzanne Oparil, Barry R. Davis, William C. Cushman, Curt D. Furberg, Charles E Ford, Julian L Haywood, Gabriel B Habib, Jeffrey L Probstfield, Karen L Margolis, Paul K. Whelton
    Abstract:

    To determine whether an angiotensin-converting enzyme inhibitor (lisinopril) or calcium channel blocker (amlodipine) is superior to a diuretic (Chlorthalidone) in reducing cardiovascular disease incidence in sex subgroups, we carried out a prespecified subgroup analysis of 15 638 women and 17 719 men in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Total follow-up (active treatment + passive surveillance using national administrative databases to ascertain deaths and hospitalizations) was 8 to 13 years. The primary outcome was fatal coronary heart disease or nonfatal myocardial infarction. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (coronary heart disease death, nonfatal myocardial infarction, stroke, angina, coronary revascularization, heart failure [HF], or peripheral vascular disease), and end-stage renal disease. In-trial rates of HF, stroke, and combined cardiovascular disease were significantly higher for lisinopril compared with Chlorthalidone, and rates of HF were significantly higher for amlodipine compared with Chlorthalidone in both men and women. There were no significant treatment sex interactions. These findings did not persist through the extension period with the exception of the HF result for amlodipine versus Chlorthalidone, which did not differ significantly by sex. For both women and men, rates were not lower in the amlodipine or lisinopril groups than in the Chlorthalidone group for either the primary coronary heart disease outcome or any other cardiovascular disease outcome, and Chlorthalidone-based treatment resulted in the lowest risk of HF. Neither lisinopril nor amlodipine is superior to Chlorthalidone for initial treatment of hypertension in either women or men. Clinical Trial Registration- clinicaltrials.gov; Identifier: NCT00000542.

  • long term renal and cardiovascular outcomes in antihypertensive and lipid lowering treatment to prevent heart attack trial allhat participants by baseline estimated gfr
    Clinical Journal of The American Society of Nephrology, 2012
    Co-Authors: Mahboob Rahman, Joshua I Barzilay, Jackson T. Wright, Barry R. Davis, Paul K. Whelton, Jeffrey A. Cutler, Charles E Ford, Linda B Piller, Clinton D Brown, Pedro J Colon
    Abstract:

    Summary Background and objectives CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with Chlorthalidone. Design, setting, participants, & measurements This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged $55 years, randomized to receive Chlorthalidone, amlodipine, or lisinopril for 4–8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m2) as follows: normal/ increased ($90; n=8027), mild reduction (60–89; n=17,778), and moderate/severe reduction (,60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD. Results After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P,0.001). In participants with an eGFR ,60, there was no significant difference in cardiovascular mortality between Chlorthalidone and amlodipine (P=0.64), or Chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD. ConclusionsCKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to Chlorthalidoneinpreventingcardiovascularevents,mortality,orESRDduring9-yearfollow-up.Becausedataon proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.

  • mortality and morbidity during and after the antihypertensive and lipid lowering treatment to prevent heart attack trial
    Journal of Clinical Hypertension, 2012
    Co-Authors: William C. Cushman, Sara L Pressel, Barry R. Davis, Paul K. Whelton, Jeffrey A. Cutler, Suzanne Oparil, Charles E Ford, Paula T Einhorn, Jeffrey L Probstfield, Jackson T. Wright
    Abstract:

    No significant differences (p < .05) appeared in cardiovascular mortality for amlodipine (HR 1.00 [0.93–1.06]) or lisinopril (HR 0.97 [0.90–1.03]), each compared to Chlorthalidone. The only significant differences in secondary outcomes were for heart failure, higher for amlodipine (HR 1.12 [1.02–1.22]), and stroke mortality, higher for lisinopril (HR 1.20 [1.01–1.41]), each compared to Chlorthalidone. Similar to the previously reported in-trial result, there was a significant treatment by race interaction for cardiovascular disease for lisinopril versus Chlorthalidone; Blacks had higher risk than non-Blacks on lisinopril compared with Chlorthalidone.. After accounting for multiple comparisons, none of these results were significant. These findings suggest that neither calcium channel blockers nor angiotensin converting-enzyme inhibitors are superior to diuretic in long-term prevention of major cardiovascular complications of hypertension.

  • blood pressure control by drug group in the antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    Journal of Clinical Hypertension, 2008
    Co-Authors: William C. Cushman, Jackson T. Wright, Barry R. Davis, Paul K. Whelton, Charles E Ford, Paula T Einhorn, Richard A Preston, Jan Basile, Robert J Weiss, Arnaud Bastien
    Abstract:

    Blood pressure (BP) control rates and number of antihypertensive medications were compared (average follow-up, 4.9 years) by randomized groups: Chlorthalidone, 12.5–25 mg/d (n=15,255), amlodipine 2.5–10 mg/d (n=9048), or lisinopril 10–40 mg/d (n=9054) in a randomized double-blind hypertension trial. Participants were hypertensives aged 55 or older with additional cardiovascular risk factor(s), recruited from 623 centers. Additional agents from other classes were added as needed to achieve BP control. BP was reduced from 145/83 mm Hg (27% control) to 134/76 mm Hg (Chlorthalidone, 68% control), 135/75 mm Hg (amlodipine, 66% control), and 136/76 mm Hg (lisinopril, 61% control) by 5 years; the mean number of drugs prescribed was 1.9, 2.0, and 2.1, respectively. Only 28% (Chlorthalidone), 24% (amlodipine), and 24% (lisinopril) were controlled on monotherapy. BP control was achieved in the majority of each randomized group—a greater proportion with Chlorthalidone. Over time, providers and patients should expect multidrug therapy to achieve BP <140/90 mm Hg in a majority of patients.

Jackson T. Wright - One of the best experts on this subject based on the ideXlab platform.

  • influence of prevalent and incident atrial fibrillation on post trial major events in allhat
    Journal of The National Medical Association, 2017
    Co-Authors: Julian L Haywood, Barry R. Davis, William C. Cushman, Jeffrey A. Cutler, Lara M Simpson, Charles E Ford, Linda B Piller, Alokananda Ghosh, Elsayed Z Soliman, Jackson T. Wright
    Abstract:

    Abstract Aims Limited information is available on long-term antihypertensive and lipid-lowering therapy effects on hypertensive patients with atrial fibrillation/flutter (AF/AFL) compared to those without. AF/AFL at baseline or during the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (mean follow-up 4.9 years) markedly increased risk of stroke, heart failure, CHD, and all-cause mortality. We aimed to determine if AF/AFL continued to impact outcomes during post-trial follow-up (mean 3.8 years). Methods Patients were randomized to Chlorthalidone, amlodipine, or lisinopril, and to pravastatin vs. usual care in the lipid-lowering trial (LLT). Of 31,473 available subjects, AF/AFL occurred in 854; 383/14,371 Chlorthalidone (2.7%), 247/8565 amlodipine (2.9%), and 224/8537 lisinopril (2.6%). Post-hoc analyses utilized administrative databases for post-trial data. Individuals with AF/AFL were compared to those without during post-trial. Outcomes were analyzed by treatment groups for the antihypertensive and LLT trials. Results Among 854 AF/AFL participants, 491 (57.5%) died: 220 in-trial, 271 post-trial. Ten-year all-cause mortality rates for those with in-trial AF/AFL were similar for Chlorthalidone and lisinopril, but lower for amlodipine (68, 66, and 49 per 100 persons, respectively); adjusted HR for amlodipine vs. Chlorthalidone was 0.68 (95% CI, 0.54–0.87). Ten-year all-cause mortality rates were 57 vs. 65 per 100 persons (pravastatin vs. usual care); non-CVD mortality rates, 18 vs. 39 per 100 persons (pravastatin vs. usual care) (adjusted HR = 0.46, 95% CI, 0.24–0.86). Conclusion Post-trial follow-up revealed continued deleterious AF/AFL effects. The amlodipine (ALLHAT) and pravastatin (ALLHAT-LLT) treatment groups showed lower all-cause and non-CVD mortality compared to the Chlorthalidone and usual-care groups, respectively.

  • long term renal and cardiovascular outcomes in antihypertensive and lipid lowering treatment to prevent heart attack trial allhat participants by baseline estimated gfr
    Clinical Journal of The American Society of Nephrology, 2012
    Co-Authors: Mahboob Rahman, Joshua I Barzilay, Jackson T. Wright, Barry R. Davis, Paul K. Whelton, Jeffrey A. Cutler, Charles E Ford, Linda B Piller, Clinton D Brown, Pedro J Colon
    Abstract:

    Summary Background and objectives CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with Chlorthalidone. Design, setting, participants, & measurements This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged $55 years, randomized to receive Chlorthalidone, amlodipine, or lisinopril for 4–8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m2) as follows: normal/ increased ($90; n=8027), mild reduction (60–89; n=17,778), and moderate/severe reduction (,60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD. Results After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P,0.001). In participants with an eGFR ,60, there was no significant difference in cardiovascular mortality between Chlorthalidone and amlodipine (P=0.64), or Chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD. ConclusionsCKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to Chlorthalidoneinpreventingcardiovascularevents,mortality,orESRDduring9-yearfollow-up.Becausedataon proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.

  • mortality and morbidity during and after the antihypertensive and lipid lowering treatment to prevent heart attack trial
    Journal of Clinical Hypertension, 2012
    Co-Authors: William C. Cushman, Sara L Pressel, Barry R. Davis, Paul K. Whelton, Jeffrey A. Cutler, Suzanne Oparil, Charles E Ford, Paula T Einhorn, Jeffrey L Probstfield, Jackson T. Wright
    Abstract:

    No significant differences (p < .05) appeared in cardiovascular mortality for amlodipine (HR 1.00 [0.93–1.06]) or lisinopril (HR 0.97 [0.90–1.03]), each compared to Chlorthalidone. The only significant differences in secondary outcomes were for heart failure, higher for amlodipine (HR 1.12 [1.02–1.22]), and stroke mortality, higher for lisinopril (HR 1.20 [1.01–1.41]), each compared to Chlorthalidone. Similar to the previously reported in-trial result, there was a significant treatment by race interaction for cardiovascular disease for lisinopril versus Chlorthalidone; Blacks had higher risk than non-Blacks on lisinopril compared with Chlorthalidone.. After accounting for multiple comparisons, none of these results were significant. These findings suggest that neither calcium channel blockers nor angiotensin converting-enzyme inhibitors are superior to diuretic in long-term prevention of major cardiovascular complications of hypertension.

  • blood pressure control by drug group in the antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    Journal of Clinical Hypertension, 2008
    Co-Authors: William C. Cushman, Jackson T. Wright, Barry R. Davis, Paul K. Whelton, Charles E Ford, Paula T Einhorn, Richard A Preston, Jan Basile, Robert J Weiss, Arnaud Bastien
    Abstract:

    Blood pressure (BP) control rates and number of antihypertensive medications were compared (average follow-up, 4.9 years) by randomized groups: Chlorthalidone, 12.5–25 mg/d (n=15,255), amlodipine 2.5–10 mg/d (n=9048), or lisinopril 10–40 mg/d (n=9054) in a randomized double-blind hypertension trial. Participants were hypertensives aged 55 or older with additional cardiovascular risk factor(s), recruited from 623 centers. Additional agents from other classes were added as needed to achieve BP control. BP was reduced from 145/83 mm Hg (27% control) to 134/76 mm Hg (Chlorthalidone, 68% control), 135/75 mm Hg (amlodipine, 66% control), and 136/76 mm Hg (lisinopril, 61% control) by 5 years; the mean number of drugs prescribed was 1.9, 2.0, and 2.1, respectively. Only 28% (Chlorthalidone), 24% (amlodipine), and 24% (lisinopril) were controlled on monotherapy. BP control was achieved in the majority of each randomized group—a greater proportion with Chlorthalidone. Over time, providers and patients should expect multidrug therapy to achieve BP <140/90 mm Hg in a majority of patients.

  • clinical outcomes by race in hypertensive patients with and without the metabolic syndrome antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    JAMA Internal Medicine, 2008
    Co-Authors: Jackson T. Wright, Sara L Pressel, Joshua I Barzilay, Henry R Black, Jan Basile, Sonja Harrishaywood, Charles Baimbridge, Charles J Bareis, Richard A Dart, Alok Gupta
    Abstract:

    Background: Antihypertensive drugs with favorable metabolic effects are advocated for first-line therapy in hypertensivepatientswithmetabolic/cardiometabolicsyndrome (MetS). We compared outcomes by race in hypertensiveindividualswithandwithoutMetStreatedwith athiazide-typediuretic(Chlorthalidone),acalciumchannel blocker (amlodipine besylate), an -blocker (doxazosin mesylate), or an angiotensin-converting enzyme inhibitor (lisinopril). Methods: A subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind hypertension treatment trial of 42418 participants. We defined MetSashypertensionplusatleast2ofthefollowing:fasting serum glucose level of at least 100 mg/dL, body mass index(calculatedasweightinkilogramsdividedbyheight in meters squared) of at least 30, fasting triglyceride levels of at least 150 mg/dL, and high-density lipoprotein cholesterol levels of less than 40 mg/dL in men or less than 50 mg/dL in women. Results: Significantly higher rates of heart failure were consistentacrossalltreatmentcomparisonsinthosewith MetS.Relativerisks(RRs)were1.50(95%confidenceinterval, 1.18-1.90), 1.49 (1.17-1.90), and 1.88 (1.422.47) in black participants and 1.25 (1.06-1.47), 1.20 (1.01-1.41), and 1.82 (1.51-2.19) in nonblack participants for amlodipine, lisinopril, anddoxazosin comparisons with Chlorthalidone, respectively. Higher rates for combined cardiovascular disease were observed with lisinopril-Chlorthalidone (RRs, 1.24 [1.09-1.40] and 1.10 [1.02-1.19], respectively) and doxazosin-Chlorthalidonecomparisons(RRs,1.37[1.19-1.58]and1.18[1.081.30], respectively) in black and nonblack participants with MetS. Higher rates of stroke were seen in black participants only (RR, 1.37 [1.07-1.76] for the lisinoprilChlorthalidonecomparison,andRR,1.49[1.09-2.03]for the doxazosin-Chlorthalidone comparison). Black patients with MetS also had higher rates of end-stage renal disease (RR, 1.70 [1.13-2.55]) with lisinopril compared with Chlorthalidone. Conclusions: The ALLHAT findings fail to support the preference for calcium channel blockers, -blockers, or angiotensin-convertingenzymeinhibitorscomparedwith thiazide-type diuretics in patients with the MetS, despite their more favorable metabolic profiles. This was particularly true for black participants. Trial Registration: clinicaltrials.gov Identifier: NCT00000542

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  • should antihypertensive treatment recommendations differ in patients with and without coronary heart disease from the antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    American Journal of Cardiology, 2016
    Co-Authors: Michael H Alderman, Sara L Pressel, Barry R. Davis, Charles E Ford, Julian L Haywood, Linda B Piller, Paula T Einhorn, Sarah M Baraniuk, Mahshid Assadi, Ekambaram Ilamathi
    Abstract:

    Thiazide-type diuretics have been recommended for initial treatment of hypertension in most patients, but should this recommendation differ for patients with and without coronary heart disease (CHD)? The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind hypertension treatment trial in 42,418 participants with high risk of combined cardiovascular disease (CVD) (25% with preexisting CHD). This post hoc analysis compares long-term major clinical outcomes in those assigned amlodipine (n = 9048) or lisinopril (n = 9,054) with those assigned Chlorthalidone (n = 15,255), stratified by CHD status. After 4 to 8 years, randomized treatment was discontinued. Total follow-up (active treatment + passive surveillance using national databases for deaths and hospitalizations) was 8 to 13 years. For most CVD outcomes, end-stage renal disease, and total mortality, there were no differences across randomized treatment arms regardless of baseline CHD status. In-trial rates of CVD were significantly higher for lisinopril compared with Chlorthalidone, and rates of heart failure were significantly higher for amlodipine compared with Chlorthalidone in those with and without CHD (overall hazard ratios [HRs] 1.10, p

  • stroke outcomes among participants randomized to Chlorthalidone amlodipine or lisinopril in allhat
    Journal of The American Society of Hypertension, 2014
    Co-Authors: Josemiguel Yamal, Barry R. Davis, William C. Cushman, Suzanne Oparil, Michael H Alderman, David A Calhoun, Herbert F Fendley, Stanley S Franklin, Gabriel B Habib, Sara L Pressel
    Abstract:

    The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind, practice-based, active-control, comparative effectiveness trial in 33,357 high-risk hypertensive participants. ALLHAT compared cardiovascular disease outcomes in participants initially treated with an angiotensin-converting enzyme inhibitor (lisinopril), a calcium channel blocker (amlodipine), or a thiazide-type diuretic (Chlorthalidone). We report stroke outcomes in 1517 participants in-trial and 1596 additional participants during post-trial passive surveillance, for a total follow-up of 8-13 years. Stroke rates were higher with lisinopril (6-year rate/100 = 6.4) than with Chlorthalidone (5.8) or amlodipine (5.5) in-trial but not including post-trial (10-year rates/100 = 13.2 [Chlorthalidone], 13.1[amlodipine], and 13.7 [lisinopril]). In-trial differences were driven by race (race-by-lisinopril/Chlorthalidone interaction P = .005, race-by-amlodipine/lisinopril interaction P = .012) and gender (gender-by-lisinopril/amlodipine interaction P = .041), separately. No treatment differences overall, or by race or gender, were detected over the 10-year period. No differences appeared among treatment groups in adjusted risk of all-cause mortality including post-trial for participants with nonfatal in-trial strokes. Among Blacks and women, lisinopril was less effective in preventing stroke in-trial than either Chlorthalidone or amlodipine, even after adjusting for differences in systolic blood pressure. These differences abated by the end of the post-trial period.

  • mortality and morbidity during and after the antihypertensive and lipid lowering treatment to prevent heart attack trial
    Journal of Clinical Hypertension, 2012
    Co-Authors: William C. Cushman, Sara L Pressel, Barry R. Davis, Paul K. Whelton, Jeffrey A. Cutler, Suzanne Oparil, Charles E Ford, Paula T Einhorn, Jeffrey L Probstfield, Jackson T. Wright
    Abstract:

    No significant differences (p < .05) appeared in cardiovascular mortality for amlodipine (HR 1.00 [0.93–1.06]) or lisinopril (HR 0.97 [0.90–1.03]), each compared to Chlorthalidone. The only significant differences in secondary outcomes were for heart failure, higher for amlodipine (HR 1.12 [1.02–1.22]), and stroke mortality, higher for lisinopril (HR 1.20 [1.01–1.41]), each compared to Chlorthalidone. Similar to the previously reported in-trial result, there was a significant treatment by race interaction for cardiovascular disease for lisinopril versus Chlorthalidone; Blacks had higher risk than non-Blacks on lisinopril compared with Chlorthalidone.. After accounting for multiple comparisons, none of these results were significant. These findings suggest that neither calcium channel blockers nor angiotensin converting-enzyme inhibitors are superior to diuretic in long-term prevention of major cardiovascular complications of hypertension.

  • cost effectiveness of Chlorthalidone amlodipine and lisinopril as first step treatment for patients with hypertension an analysis of the antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    Journal of General Internal Medicine, 2008
    Co-Authors: Paul A Heidenreich, Sara L Pressel, Chuke Nwachuku, Barry R. Davis, Jeffrey A. Cutler, Curt D. Furberg, David R Lairson, Michael G Shlipak, Lee Goldman
    Abstract:

    To evaluate the cost-effectiveness of first-line treatments for hypertension. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) found that first-line treatment with lisinopril or amlodipine was not significantly superior to Chlorthalidone in terms of the primary endpoint, so differences in costs may be critical for optimizing decision-making. Cost-effectiveness analysis was performed using bootstrap resampling to evaluate uncertainty. Over a patient’s lifetime, Chlorthalidone was always least expensive (mean $4,802 less than amlodipine, $3,700 less than lisinopril). Amlodipine provided more life-years (LYs) than Chlorthalidone in 84% of bootstrap samples (mean 37 days) at an incremental cost-effectiveness ratio of $48,400 per LY gained. Lisinopril provided fewer LYs than Chlorthalidone in 55% of bootstrap samples (mean 7-day loss) despite a higher cost. At a threshold of $50,000 per LY gained, amlodipine was preferred in 50%, Chlorthalidone in 40%, and lisinopril in 10% of bootstrap samples, but these findings were highly sensitive to the cost of amlodipine and the cost-effectiveness threshold chosen. Incorporating quality of life did not appreciably alter the results. Overall, no reasonable combination of assumptions led to 1 treatment being preferred in over 90% of bootstrap samples. Initial treatment with Chlorthalidone is less expensive than lisinopril or amlodipine, but amlodipine provided a nonsignificantly greater survival benefit and may be a cost-effective alternative. A randomized trial with power to exclude “clinically important” differences in survival will often have inadequate power to determine the most cost-effective treatment.

  • clinical outcomes by race in hypertensive patients with and without the metabolic syndrome antihypertensive and lipid lowering treatment to prevent heart attack trial allhat
    JAMA Internal Medicine, 2008
    Co-Authors: Jackson T. Wright, Sara L Pressel, Joshua I Barzilay, Henry R Black, Jan Basile, Sonja Harrishaywood, Charles Baimbridge, Charles J Bareis, Richard A Dart, Alok Gupta
    Abstract:

    Background: Antihypertensive drugs with favorable metabolic effects are advocated for first-line therapy in hypertensivepatientswithmetabolic/cardiometabolicsyndrome (MetS). We compared outcomes by race in hypertensiveindividualswithandwithoutMetStreatedwith athiazide-typediuretic(Chlorthalidone),acalciumchannel blocker (amlodipine besylate), an -blocker (doxazosin mesylate), or an angiotensin-converting enzyme inhibitor (lisinopril). Methods: A subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind hypertension treatment trial of 42418 participants. We defined MetSashypertensionplusatleast2ofthefollowing:fasting serum glucose level of at least 100 mg/dL, body mass index(calculatedasweightinkilogramsdividedbyheight in meters squared) of at least 30, fasting triglyceride levels of at least 150 mg/dL, and high-density lipoprotein cholesterol levels of less than 40 mg/dL in men or less than 50 mg/dL in women. Results: Significantly higher rates of heart failure were consistentacrossalltreatmentcomparisonsinthosewith MetS.Relativerisks(RRs)were1.50(95%confidenceinterval, 1.18-1.90), 1.49 (1.17-1.90), and 1.88 (1.422.47) in black participants and 1.25 (1.06-1.47), 1.20 (1.01-1.41), and 1.82 (1.51-2.19) in nonblack participants for amlodipine, lisinopril, anddoxazosin comparisons with Chlorthalidone, respectively. Higher rates for combined cardiovascular disease were observed with lisinopril-Chlorthalidone (RRs, 1.24 [1.09-1.40] and 1.10 [1.02-1.19], respectively) and doxazosin-Chlorthalidonecomparisons(RRs,1.37[1.19-1.58]and1.18[1.081.30], respectively) in black and nonblack participants with MetS. Higher rates of stroke were seen in black participants only (RR, 1.37 [1.07-1.76] for the lisinoprilChlorthalidonecomparison,andRR,1.49[1.09-2.03]for the doxazosin-Chlorthalidone comparison). Black patients with MetS also had higher rates of end-stage renal disease (RR, 1.70 [1.13-2.55]) with lisinopril compared with Chlorthalidone. Conclusions: The ALLHAT findings fail to support the preference for calcium channel blockers, -blockers, or angiotensin-convertingenzymeinhibitorscomparedwith thiazide-type diuretics in patients with the MetS, despite their more favorable metabolic profiles. This was particularly true for black participants. Trial Registration: clinicaltrials.gov Identifier: NCT00000542