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Clin J Am Soc Nephrol ; 7(6): 989-1002, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22490878

ABSTRACT

BACKGROUND AND OBJECTIVES: CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with chlorthalidone. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a long-term post-trial follow-up of hypertensive participants (n=31,350), aged ≥55 years, randomized to receive chlorthalidone, amlodipine, or lisinopril for 4-8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m(2)) as follows: normal/increased (≥90; n=8027), mild reduction (60-89; n=17,778), and moderate/severe reduction (<60; n=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD. RESULTS: After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (P<0.001). In participants with an eGFR <60, there was no significant difference in cardiovascular mortality between chlorthalidone and amlodipine (P=0.64), or chlorthalidone and lisinopril (P=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD. CONCLUSIONS: CKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up. Because data on proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.


Subject(s)
Amlodipine/therapeutic use , Antihypertensive Agents/therapeutic use , Chlorthalidone/therapeutic use , Glomerular Filtration Rate , Hypertension/drug therapy , Hypolipidemic Agents/therapeutic use , Kidney Diseases/drug therapy , Kidney/physiopathology , Lisinopril/therapeutic use , Myocardial Infarction/prevention & control , Canada , Chronic Disease , Coronary Disease/etiology , Coronary Disease/mortality , Coronary Disease/prevention & control , Double-Blind Method , Female , Heart Failure/etiology , Heart Failure/mortality , Heart Failure/prevention & control , Humans , Hypertension/complications , Hypertension/mortality , Hypertension/physiopathology , Incidence , Kaplan-Meier Estimate , Kidney Diseases/complications , Kidney Diseases/mortality , Kidney Diseases/physiopathology , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/prevention & control , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/etiology , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Proportional Hazards Models , Puerto Rico , Risk Assessment , Risk Factors , Severity of Illness Index , Stroke/etiology , Stroke/mortality , Stroke/prevention & control , Time Factors , Treatment Outcome , United States , United States Virgin Islands
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