Longer-term follow up of heart failure patients in ALLHAT

January 01, 0001

Longer-term follow up of heart failure patients in ALLHAT

These US researchers performed a longer term follow up of participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). This randomized, double-blind, comparative effectiveness trial in high-risk hypertensive participants found varying rates of new onset heart failure (HF) among various antihypertensive medications. Following the randomized phase of the trial, subsequent date was obtained from administrative databases (mean follow-up of 8.9 years).

The researchers found: "Of 1761 participants with incident HF in- trial, 1348 died. Post-HF all-cause mortality was similar across treatment groups, with adjusted hazard ratios of 0.95 and 1.05, respectively, for amlodipine and lisinopril compared with chlorthalidone, and 10-year adjusted rates of 86%, 87%, and 83%, respectively. All-cause mortality rates were also similar among those with reduced ejection fractions (84%) and preserved ejection fractions (81%), with no significant differences by randomized treatment arm."

The researchers concluded: "Once HF develops, risk of death is high and consistent across randomized treatment groups. Measures to prevent the development of HF, especially blood pressure control, must be a priority if mortality associated with the development of HF is to be addressed."

This data reinforces the high mortality risk from heart failure and found no evidence any of the ALLHAT treatment arms improved outcomes.

For the full abstract, click here.

Circulation 124(17):1811-1818, 25 October 2011 © 2011 American Heart Association, Inc.
Long-Term Follow-Up of Participants With Heart Failure in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Linda B. Piller, Sarah Baraniuk, Lara M. Simpson, et al. Correspondence to Linda B. Piller: Linda.B.Piller@uth.tmc.edu

Category: K. Circulatory. Keywords: heart failure, mortality, amlodipine, lisinopril, chlorthalidone, randomize comparative effectiveness trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 8 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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