Title: Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Li
1Outcomes in Hypertensive Black and Nonblack
Patients Treated with Chlorthalidone, Amlodipine,
and LisinoprilWright JT, Dunn JK, Cutler JA et
al. JAMA 20052931595-1608.
2Randomized Design of ALLHAT BP Trial
42,418 High-risk hypertensive patients
Consent / Randomize
Amlodipine Chlorthalidone Doxazosin Lisinopril
Follow until death or end of study (4-8 years,
mean 4.9 years)
3Race Subgroup Analysis
- ALLHAT reported no differences in the primary CHD
outcome, but overall superiority of thiazide-type
diuretic for first-step therapy of hypertension
based on differences in secondary outcomes - The population of blacks with hypertension has
the highest morbidity and mortality from
hypertension of any population group in the U.S. - Race was a prespecified subgroup for ALLHAT
4Baseline Characteristics by Race(Chlorthalidone,
Amlodipine, Lisinopril)
5 Blood Pressure at 5 Yearsby Race
P lt 0.005 compared to Chlorthalidone
6BP Results by Treatment Group by Race
7 on 3 Antihypertensive Drugs by Randomized
Group and Race at 5 Years
8BP Control (lt140/90 mm Hg) and Mean BP by
Randomized Group and Race at 5 Years
135/78
136/76
139/79
133/74
134/74
134/74
9Serum Potassium(mean mmol/l)by Treatment Group
and Race
10Serum Cholesterol(mean mg/dl)by Treatment Group
and Race
11Fasting Glucose(mean mg/dl)by Treatment Group
and Race
12Fasting Glucose ?126 mg/dlby Treatment Group and
Race
13Black vs. Non-Black Amlodipine/Chlorthalidone Rela
tive Risk and 95 Confidence Intervals
Non-Black
0.97 (0.87 - 1.08)
0.94 (0.87 - 1.03)
0.99 (0.92 - 1.07)
1.04 (0.97 - 1.10)
0.93 (0.79 - 1.10)
1.08 (0.79 - 1.48)
1.32 (1.17 - 1.49)
0.50
1
2
Favors Chlorthalidone
Favors Amlodipine
14Black vs. Non-Black Lisinopril/Chlorthalidone Rela
tive Risk and 95 Confidence Intervals
Black
Favors Chlorthalidone
Favors Lisinopril
15Heart Failure Rate for Blacks by Treatment Group
16(No Transcript)
17ANGIOEDEMA
There were 3 cases (lt0.1) of angioedema in the
amlodipine group (comparison to chlorthalidone
not significant).
18Antihypertensive TrialImplications
- Diuretics should be the drug of choice for
initial therapy of hypertension. The evidence
for this recommendation is even stronger for
Black hypertensive patients.. - For the patient who cannot take a diuretic (which
should be an unusual circumstance), CCBs and
ACEIs may be considered. However, in Black
hypertensive patients, ACEIs should be
considered second-line therapy. - Most hypertensive patients require more than one
drug. Diuretics should generally be part of the
antihypertensive regimen. Lifestyle advice should
also be provided.
19Extra Slides
20Blacks Amlodipine/Chlorthalidone Relative Risk
and 95 Confidence Intervals
0.50
1
2
Favors Amlodipine Favors
Chlorthalidone
21Blacks Lisinopril/Chlorthalidone Relative Risk
and 95 Confidence Interval
0.50
1
2
Favors Lisinopril Favors
Chlorthalidone
22Non-Blacks Amlodipine/Chlorthalidone Relative
Risk and 95 Confidence Intervals
2
0.50
1
Favors Amlodipine Favors
Chlorthalidone
23Non-Blacks Lisinopril/Chlorthalidone Relative
Risk and 95 Confidence Intervals
0.50 1 2
Favors Lisinopril Favors
Chlorthalidone