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ALLHAT Antihypertensive Trial Results by Baseline Diabetic Status

ALLHAT Antihypertensive Trial Results by Baseline Diabetic Status. January 28, 2004. ALLHAT. Introduction and Background. Clinical trials have reported reduction in CV events with diuretics, CCBs, ACE inhibitors, b -blockers, and ARBs.

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ALLHAT Antihypertensive Trial Results by Baseline Diabetic Status

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  1. ALLHAT Antihypertensive Trial Results by Baseline Diabetic Status January 28, 2004

  2. ALLHAT Introduction and Background • Clinical trials have reported reduction in CV events with diuretics, CCBs, ACE inhibitors, b-blockers, and ARBs. • Concerns have been raised regarding effects of some classes in diabetes. • JNC7 guidelines indicate all these classes are acceptable.

  3. History of Diabetes at Baseline • Medical record evidence in the past 2 years (1 or more of the following): • Fasting glucose >140 mg/dl • Non-fasting glucose >200 mg/dl • On insulin or oral hypoglycemic agents

  4. Baseline CharacteristicsDiabetic and Nondiabetic Participants* *Randomized to chlorthalidone, amlodipine, or lisinopril.

  5. BP Results by Treatment Group and Baseline Diabetic Status

  6. Blood Pressure at 5 Yearsby Baseline Diabetic Status The SBP difference between lisinopril and chlorthalidone was larger in diabetic (+3.0 mm Hg) than for nondiabetic participants (1.3 mm Hg) (p=0.04).

  7. Biochemical Measures at 4 Yearsin Participants with Diabetes

  8. Biochemical Measures at 4 Yearsin Participants without Diabetes

  9. Potassium Supplementation at 4 Yearsin Participants with and withoutDiabetes at Baseline

  10. CHD by Antihypertensive Treatment Group In Participants With Diabetes at Baseline .2 .16 Chlorthalidone Amlodipine Lisinopril .12 Cumulative CHD Event Rate .08 .04 0 0 1 2 3 4 5 6 7 Years to CHD Event

  11. CHD by Antihypertensive Treatment Group In Participants Without Diabetes at Baseline .2 .16 Chlorthalidone Amlodipine Lisinopril .12 Cumulative CHD Event Rate .08 .04 0 0 1 2 3 4 5 6 7 Years to CHD Event

  12. All-Cause Mortality by Antihypertensive Treatment Group In Participants With Diabetes at Baseline .28 .24 .2 Chlorthalidone Amlodipine Lisinopril .16 Cumulative Mortality Rate .12 .08 .04 0 0 1 2 3 4 5 6 7 Years to Death

  13. All-Cause Mortality by Antihypertensive Treatment Group In Participants Without Diabetes at Baseline .28 .24 .2 Chlorthalidone Amlodipine Lisinopril .16 Cumulative Mortality Rate .12 .08 .04 0 0 1 2 3 4 5 6 7 Years to Death

  14. Stroke by Antihypertensive Treatment Group In Participants With Diabetes at Baseline .12 .08 Chlorthalidone Amlodipine Lisinopril Cumulative Stroke Rate .04 0 0 1 2 3 4 5 6 7 Years to Stroke

  15. Stroke by Antihypertensive Treatment Group In Participants Without Diabetes at Baseline .12 .08 Chlorthalidone Amlodipine Lisinopril Cumulative Stroke Rate .04 0 0 1 2 3 4 5 6 7 Years to Stroke

  16. Heart Failure by Antihypertensive Treatment Group In Participants With Diabetes at Baseline .2 .16 .12 Chlorthalidone Amlodipine Lisinopril Cumulative HF Rate .08 .04 0 0 1 2 3 4 5 6 7 Years to HF

  17. Heart Failure by Antihypertensive Treatment Group In Participants Without Diabetes at Baseline .2 .16 .12 Chlorthalidone Amlodipine Lisinopril Cumulative HF Rate .08 .04 0 0 1 2 3 4 5 6 7 Years to HF

  18. Combined CVD by Antihypertensive Treatment Group In Participants With Diabetes at Baseline .4 .3 .2 Cumulative Combined CVD Event Rate Chlorthalidone Amlodipine Lisinopril .1 0 0 1 2 3 4 5 6 7 Years to Combined CVD Event

  19. Combined CVD by Antihypertensive Treatment Group In Participants Without Diabetes at Baseline .4 .3 Cumulative Combined CVD Event Rate .2 Chlorthalidone Amlodipine Lisinopril .1 0 0 1 2 3 4 5 6 7 Years to Combined CVD Event

  20. End Stage Renal Disease by Antihypertensive Treatment Group In Participants With Diabetes at Baseline 0.05 0.04 0.03 Cumulative ESRD Rate 0.02 0.01 0 1 2 3 4 5 6 7 Years to ESRD 0.05 0.04 0.03 0.02 0.01 0.00

  21. End Stage Renal Disease by Antihypertensive Treatment Group In Participants Without Diabetes at Baseline 0.05 0.04 0.03 Cumulative ESRD Rate Chlorthalidone Amlodipine Lisinopril 0.02 0.01 0 1 2 3 4 5 6 7 Years to ESRD 0.05 0.04 0.03 0.02 0.01 0.00

  22. Diabetics & NondiabeticsAmlodipine/Chlorthalidone Relative Risk and 95% Confidence Intervals 1 2 0.50 0.50 1 2 Favors Favors Amlodipine Chlorthal Favors Favors Amlodipine Chlorthal There is no difference in treatment group effect by baseline history of diabetes.

  23. 2 0.50 1 Diabetics & NondiabeticsLisinopril/Chlorthalidone Relative Risk and 95% Confidence Intervals 0.50 1 2 Favors Favors Lisinopril Chlorthal Favors Favors Lisinopril Chlorthal There is no difference in treatment group effect by baseline history of diabetes.

  24. ESRD Events and Estimated GFRby Baseline Diabetes Status

  25. ALLHAT Results by Baseline Diabetic Status - Conclusions • Treatment group comparison results were similar in diabetic and nondiabetic participants • For both diabetic and nondiabetic participants, there were significant advantages for the diuretic arm • Compared with the ACEI and CCB arms, there was less HF • Compared with the ACEI arm, there was less stroke and less combined CVD

  26. ALLHAT Results - Overall • Because of the superiority of thiazide-type diuretics in preventing one or more major forms of CVD and their lower cost, they should be the drugs of choice for first-step antihypertensive drug therapy in both diabetic and nondiabetic participants.

  27. Additional Slides

  28. BP Results – Amlodipine vs Chlorthalidoneand Baseline Diabetic Status

  29. BP Results – Lisinopril vs Chlorthalidoneand Baseline Diabetic Status

  30. Outcomes in Participants with Diabetes –Amlodipine Compared With Chlorthalidone

  31. Outcomes in Participants with Diabetes –Lisinopril Compared with Chlorthalidone

  32. Outcomes in Participants without Diabetes –Amlodipine Compared with Chlorthalidone

  33. Outcomes in Participants without Diabetes –Lisinopril Compared with Chlorthalidone

  34. DiabeticsAmlodipine/Chlorthalidone Relative Risk and 95% Confidence Intervals 1 2 0.50 Favors Amlodipine Favors Chlorthalidone

  35. 2 0.50 1 DiabeticsLisinopril/Chlorthalidone Relative Risk and 95% Confidence Intervals Favors Lisinopril Favors Chlorthalidone

  36. NondiabeticsAmlodipine/Chlorthalidone Relative Risk and 95% Confidence Intervals 0.50 1 2 FavorsAmlodipineFavorsChlorthalidone

  37. NondiabeticsLisinopril/Chlorthalidone Relative Risk and 95% Confidence Intervals 0.50 1 2 Favors Lisinopril Favors Chlorthalidone

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