Blood pressure control and cardiovascular outcomes in normal-weight, overweight,
and obese hypertensive patients treated with three different antihypertensives in
ALLHAT.
Author(s): Reisin E(1), Graves JW, Yamal JM, Barzilay JI, Pressel SL, Einhorn PT, Dart RA,
Retta TM, Saklayen MG, Davis BR; ALLHAT Collaborative Research Group.
Affiliation(s): Author information:
(1)aSection of Nephrology and Hypertension, Louisiana State University Health
Science Center, New Orleans, Louisiana bDivision of Nephrology/Hypertension, Mayo
Clinic, Rochester, Minnesota cCoordinating Center for Clinical Trials, The
University of Texas School of Public Health, Houston, Texas dDivision of
Endocrinology, Kaiser Permanente of Georgia and Emory University School of
Medicine, Atlanta, Georgia eThe National Heart, Lung, and Blood Institute,
Bethesda, Maryland fCenter for Human Genetics, Marshfield Clinic Research
Foundation, Marshfield, Wisconsin gHoward University Hypertension and Lipid
Clinic, Howard University Hospital, Washington, District of Columbia hVeterans
Affairs Medical Center and Wright State University Veterans Affairs Campus,
Dayton, Ohio, USA.
Publication date & source: 2014, J Hypertens. , 32(7):1503-13; discussion 1513
OBJECTIVE: Epidemiologically, there is a strong relationship between BMI and
blood pressure (BP) levels. We prospectively examined randomization to first-step
chlorthalidone, a thiazide-type diuretic; amlodipine, a calcium-channel blocker;
and lisinopril, an angiotensin-converting enzyme inhibitor, on BP control and
cardiovascular outcomes in a hypertensive cohort stratified by baseline BMI
[kg/m(2); normal weight (BMI <25), overweight (BMI = 25-29.9), and obese (BMI
>30)].
METHODS: In a randomized, double-blind, practice-based Antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial, 33,357 hypertensive
participants, aged at least 55 years, were followed for an average of 4.9 years,
for a primary outcome of fatal coronary heart disease or nonfatal myocardial
infarction, and secondary outcomes of stroke, heart failure, combined
cardiovascular disease, mortality, and renal failure.
RESULTS: Of participants, 37.9% were overweight and 42.1% were obese at
randomization. For each medication, BP control (<140/90 mmHg) was equivalent in
each BMI stratum. At the fifth year, 66.1, 66.5, and 65.1% of normal-weight,
overweight, and obese participants, respectively, were controlled. Those
randomized to chlorthalidone had highest BP control (67.2, 68.3, and 68.4%,
respectively) and to lisinopril the lowest (60.4, 63.2, and 59.6%, respectively)
in each BMI stratum. A significant interaction (P = 0.004) suggests a lower
coronary heart disease risk in the obese for lisinopril versus chlorthalidone
(hazard ratio 0.85, 95% confidence interval 0.74-0.98) and a significant
interaction (P = 0.011) suggests a higher risk of end-stage renal disease for
amlodipine versus chlorthalidone in obese participants (hazard ratio 1.49, 95%
confidence interval 1.06-2.08). However, these results were not consistent among
other outcomes.
CONCLUSION: BMI status does not modify the effects of antihypertensive
medications on BP control or cardiovascular disease outcomes.
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