How much effect of different antihypertensive medications on cardiovascular outcomes is attributable to their effects on blood pressure? Stat Med 2013 Feb 28;32(5):884-97
Date
09/11/2012Pubmed ID
22961832DOI
10.1002/sim.5580Scopus ID
2-s2.0-84873451659 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
The debate over whether certain antihypertensive medications have benefits beyond what would be expected from their blood pressure lowering spurred the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, which randomized 42,418 participants to chlorthalidone (15,255), amlodipine (9048), lisinopril (9054), or doxazosin (9061). We compared chlorthalidone, the active control, with each of the other three agents with respect to the primary outcome, fatal coronary heart disease or nonfatal myocardial infarction, and several other clinical endpoints. The arms were similar with respect to the primary endpoint, although some differences were found for other endpoints, most notably heart failure. Although the desire was to achieve similar blood pressure reductions in the four arms, we found some systolic blood pressure and diastolic blood pressure differences. A natural question is to what degree can observed treatment group differences in cardiovascular outcomes be attributed to these blood pressure differences. The purpose of this paper was to delineate the problems inherent in attempting to answer this question, and to present analyses intended to overcome these problems.
Author List
Proschan M, Ford CE, Cutler JA, Graumlich JF, Pavlik V, Cushman WC, Davis BR, Alderman MH, Gordon D, Furberg CD, Franklin SS, Blumenthal SS, Castaldo RS, Preston RA, LHAT Collaborative Research GroupAuthor
Samuel S. Blumenthal MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AmlodipineAntihypertensive Agents
Biostatistics
Blood Pressure
Cardiovascular Diseases
Chlorthalidone
Coronary Disease
Endpoint Determination
Heart Failure
Humans
Hypertension
Lisinopril
Myocardial Infarction
Randomized Controlled Trials as Topic
Regression Analysis
Treatment Outcome
