This study, published in JAMA Network Open, investigated the long-term effects of different antihypertensive drugs on cardiovascular disease (CVD) and mortality in participants of the ALLHAT trial. The participants were followed for up to 23 years after randomization to either a thiazide-type diuretic (chlorthalidone), a calcium channel blocker (CCB), or an angiotensin-converting enzyme (ACE) inhibitor (lisinopril).

Key findings:

• All three groups had similar rates of cardiovascular disease mortality after 23 years.

• Compared to the diuretic group, the ACE inhibitor group had a 19% increased risk of stroke mortality and an 11% increased risk of combined fatal and nonfatal stroke.

• The calcium channel blocker group did not show any significant differences in CVD or stroke outcomes compared to the diuretic group.

• The increased risk of stroke associated with ACE inhibitors persisted throughout the entire follow-up period.

• The study used administrative data to track outcomes after the end of the trial, which is a cost-effective approach but has limitations such as potential bias and missing data.

In a meticulous secondary analysis encompassing 32,804 participants over 23 years, the ALLHAT study sought to decipher the long-term cardiovascular impacts of different antihypertensive treatments. The primary findings revealed no significant difference in mortality due to cardiovascular disease (CVD) among the three treatment groups—thiazide-type diuretics, calcium channel blockers (CCB), and angiotensin-converting enzyme (ACE) inhibitors.

Stroke Outcomes: A Closer Look

Despite the overall similarity in CVD mortality, a nuanced revelation emerged regarding stroke outcomes. The ACE inhibitor group exhibited an increased risk compared to diuretics, with statistical significance initially observed. However, upon meticulous consideration of multiple comparisons, this increased risk lost statistical significance.

Decoding ALLHAT Study Design and Participants

Rigorous Methodology for Robust Insights

The ALLHAT study, conducted from February 23, 1994, to December 31, 2017, stands as a testament to rigorous scientific inquiry. This multicenter randomized clinical trial, involving participants aged 55 years or older diagnosed with hypertension and at least one other coronary heart disease risk factor, aimed to unravel the long-term posttrial risks associated with various antihypertensive interventions.

Navigating Interventions and Outcomes

Randomized Assignments and Long-Term Follow-Up

Participants were randomly assigned to receive a thiazide-type diuretic, CCB, or ACE inhibitor. The in-trial follow-up spanned 4 to 8 years, followed by an extensive passive follow-up of up to 23 years. The primary endpoint focused on mortality due to CVD, with secondary outcomes encompassing all-cause mortality, combined fatal and nonfatal CVD, and specific outcomes for coronary heart disease, stroke, heart failure, end-stage renal disease, and cancer.

Key Insights from ALLHAT Study Results

Demographic Snapshot and Cardiovascular Disease Mortality Rates

The study cohort, comprising 32,804 participants, exhibited a mean age of 66.9 years, with notable representation from both genders and diverse ethnic backgrounds. Cardiovascular disease mortality rates per 100 persons after 23 years were 23.7, 21.6, and 23.8 in the diuretic, CCB, and ACE inhibitor groups, respectively. Adjusted hazard ratios indicated no significant differences between CCB vs. diuretic (AHR 0.97) and ACE inhibitor vs. diuretic (AHR 1.06).

Unraveling Stroke Outcomes: A Distinct Risk

While the overall long-term risks for secondary outcomes were comparable, the ACE inhibitor group presented a distinctive risk profile. A 19% increased risk of stroke mortality (AHR 1.19) and an 11% increased risk of combined fatal and nonfatal hospitalized stroke (AHR 1.11) were observed when compared with the diuretic group.

Key Points

1. The study analyzed the long-term effects of antihypertensive drugs on CVD and mortality in ALLHAT participants.

2. Follow-up lasted up to 23 years after randomization to diuretics, CCBs, or ACE inhibitors.

3. All groups had similar CVD mortality rates after 23 years.

4. ACE inhibitors increased stroke risk compared to diuretics (19% for mortality, 11% for combined fatal and nonfatal).

5. CCBs showed no significant differences in CVD or stroke outcomes compared to diuretics.

6. Increased stroke risk with ACE inhibitors persisted throughout the follow-up period.

Concluding Thoughts: Bridging the Gap in Cardiovascular Insights

In conclusion, this prespecified secondary analysis of the ALLHAT study sheds light on the nuanced interplay of antihypertensive interventions and long-term cardiovascular outcomes. While overall CVD mortality remained consistent across groups, the heightened risk of stroke outcomes in the ACE inhibitor group persisted well beyond the trial period. These findings underscore the importance of continuous exploration and refined treatment strategies to guide cardiovascular care practices in an evolving landscape.

Reference Article

Yamal, J. M., Martinez, J., Osani, M. C., Du, X. L., Simpson, L. M., & Davis, B. R. (2023, December 4). Mortality and Morbidity Among Individuals With Hypertension Receiving a Diuretic, ACE Inhibitor, or Calcium Channel Blocker. JAMA Network Open, 6(12), e2344998. https://doi.org/10.1001/jamanetworkopen.2023.44998

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https://healthnewstrend.com/are-you-ignoring-your-blood-pressure-women-at-higher-risk-study-finds

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