دورية أكاديمية
أعرض في EDS

Mortality and Morbidity Among Individuals With Hypertension Receiving a Diuretic, ACE Inhibitor, or Calcium Channel Blocker: A Secondary Analysis of a Randomized Clinical Trial.

التفاصيل البيبلوغرافية
العنوان: Mortality and Morbidity Among Individuals With Hypertension Receiving a Diuretic, ACE Inhibitor, or Calcium Channel Blocker: A Secondary Analysis of a Randomized Clinical Trial.
المؤلفون: Yamal JM; Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston., Martinez J; Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston., Osani MC; Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston.; Zimmer Biomet, Warsaw, Indiana., Du XL; Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston., Simpson LM; Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston., Davis BR; Coordinating Center for Clinical Trials, Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston.
المصدر: JAMA network open [JAMA Netw Open] 2023 Dec 01; Vol. 6 (12), pp. e2344998. Date of Electronic Publication: 2023 Dec 01.
نوع المنشور: Randomized Controlled Trial; Multicenter Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Cardiovascular Diseases*/epidemiology , Hypertension*/drug therapy , Stroke* , Coronary Disease*, Adult ; Male ; Female ; Humans ; Aged ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Diuretics/therapeutic use ; Antihypertensive Agents/therapeutic use ; Calcium Channel Blockers/therapeutic use ; Thiazides ; Sodium Chloride Symporter Inhibitors/therapeutic use ; Antiviral Agents
مستخلص: Importance: The long-term relative risk of antihypertensive treatments with regard to mortality and morbidity is not well understood.
Objective: To determine the long-term posttrial risk of primary and secondary outcomes among trial participants who were randomized to either a thiazide-type diuretic, calcium channel blocker (CCB), or angiotensin-converting enzyme (ACE) inhibitor with up to 23 years of follow-up.
Design, Setting, and Participants: This prespecified secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a multicenter randomized, double-blind, active-controlled clinical trial, followed up with participants aged 55 years or older with a diagnosis of hypertension and at least 1 other coronary heart disease risk factor for up to 23 years, from February 23, 1994, to December 31, 2017. Trial participants were linked with administrative databases for posttrial mortality (N = 32 804) and morbidity outcomes (n = 22 754). Statistical analysis was performed from January 2022 to October 2023.
Interventions: Participants were randomly assigned to receive a thiazide-type diuretic (n = 15 002), a CCB (n = 8898), or an ACE inhibitor (n = 8904) for planned in-trial follow-up of approximately 4 to 8 years and posttrial passive follow-up for up to 23 years.
Main Outcomes and Measures: The primary end point was mortality due to cardiovascular disease (CVD). Secondary outcomes included all-cause mortality, combined fatal and nonfatal (morbidity) CVD, and both mortality and morbidity for coronary heart disease, stroke, heart failure, end-stage renal disease, and cancer.
Results: A total of 32 804 participants (mean [SD] age, 66.9 [7.7] years; 17 411 men [53.1%]; and 11 772 Black participants [35.9%]) were followed up for all-cause mortality and a subgroup of 22 754 participants (mean [SD] age, 68.7 [7.2] years; 12 772 women [56.1%]; and 8199 Black participants [36.0%]) were followed up for fatal or nonfatal CVD through 2017 (mean [SD] follow-up, 13.7 [6.7] years; maximum follow-up, 23.9 years). Cardiovascular disease mortality rates per 100 persons were 23.7, 21.6, and 23.8 in the diuretic, CCB, and ACE inhibitor groups, respectively, at 23 years after randomization (adjusted hazard ratio [AHR], 0.97 [95% CI, 0.89-1.05] for CCB vs diuretic; AHR, 1.06 [95% CI, 0.97-1.15] for ACE inhibitor vs diuretic). The long-term risks of most secondary outcomes were similar among the 3 groups. Compared with the diuretic group, the ACE inhibitor group had a 19% increased risk of stroke mortality (AHR, 1.19 [95% CI, 1.03-1.37]) and an 11% increased risk of combined fatal and nonfatal hospitalized stroke (AHR, 1.11 [95% CI, 1.03-1.20]).
Conclusions and Relevance: In this secondary analysis of a randomized clinical trial in an adult population with hypertension and coronary heart disease risk factors, CVD mortality was similar between all 3 groups. ACE inhibitors increased the risk of stroke outcomes by 11% compared with diuretics, and this effect persisted well beyond the trial period.
Trial Registration: ClinicalTrials.gov Identifier: NCT00000542.
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معلومات مُعتمدة: R01 AG058971 United States AG NIA NIH HHS; R01 AG067498 United States AG NIA NIH HHS
سلسلة جزيئية: ClinicalTrials.gov NCT00000542
المشرفين على المادة: 0 (Angiotensin-Converting Enzyme Inhibitors)
0 (Diuretics)
0 (Antihypertensive Agents)
0 (Calcium Channel Blockers)
0 (Thiazides)
0 (Sodium Chloride Symporter Inhibitors)
0 (Antiviral Agents)
تواريخ الأحداث: Date Created: 20231204 Date Completed: 20231205 Latest Revision: 20231207
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC10696481
DOI: 10.1001/jamanetworkopen.2023.44998
PMID: 38048133
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2023.44998