Efrain Reisin1, John W Graves, José-Miguel Yamal, Joshua I Barzilay, Sara L Pressel, Paula T Einhorn, Richard A Dart, Tamrat M Retta, Mohammad G Saklayen, Barry R Davis. 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.
Abstract
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.
RCT Entities:
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 hypertensiveparticipants, 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 obeseparticipants, 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 obeseparticipants (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.
Authors: Paula T Einhorn; Barry R Davis; Barry M Massie; William C Cushman; Linda B Piller; Lara M Simpson; Daniel Levy; Chuke E Nwachuku; Henry R Black Journal: Am Heart J Date: 2007-01 Impact factor: 4.749
Authors: B R Davis; J A Cutler; D J Gordon; C D Furberg; J T Wright; W C Cushman; R H Grimm; J LaRosa; P K Whelton; H M Perry; M H Alderman; C E Ford; S Oparil; C Francis; M Proschan; S Pressel; H R Black; C M Hawkins Journal: Am J Hypertens Date: 1996-04 Impact factor: 2.689
Authors: Michael Proschan; Charles E Ford; Jeffrey A Cutler; James F Graumlich; Valory Pavlik; William C Cushman; Barry R Davis; Michael H Alderman; David Gordon; Curt D Furberg; Stanley S Franklin; Samuel S Blumenthal; Richard S Castaldo; Richard A Preston Journal: Stat Med Date: 2012-09-07 Impact factor: 2.373
Authors: Salim Yusuf; Steven Hawken; Stephanie Ounpuu; Leonelo Bautista; Maria Grazia Franzosi; Patrick Commerford; Chim C Lang; Zvonko Rumboldt; Churchill L Onen; Liu Lisheng; Supachai Tanomsup; Paul Wangai; Fahad Razak; Arya M Sharma; Sonia S Anand Journal: Lancet Date: 2005-11-05 Impact factor: 79.321
Authors: Peter Bramlage; David Pittrow; Hans-Ulrich Wittchen; Wilhelm Kirch; Steffen Boehler; Hendrik Lehnert; Michael Hoefler; Thomas Unger; Arya M Sharma Journal: Am J Hypertens Date: 2004-10 Impact factor: 2.689
Authors: Stevo Julius; Shawna D Nesbitt; Brent M Egan; Michael A Weber; Eric L Michelson; Niko Kaciroti; Henry R Black; Richard H Grimm; Franz H Messerli; Suzanne Oparil; M Anthony Schork Journal: N Engl J Med Date: 2006-03-14 Impact factor: 91.245
Authors: Jens Jordan; Volkan Yumuk; Markus Schlaich; Peter M Nilsson; Barbara Zahorska-Markiewicz; Guido Grassi; Roland E Schmieder; Stefan Engeli; Nick Finer Journal: J Hypertens Date: 2012-06 Impact factor: 4.844
Authors: Giuseppe Mancia; Robert Fagard; Krzysztof Narkiewicz; Josep Redon; Alberto Zanchetti; Michael Böhm; Thierry Christiaens; Renata Cifkova; Guy De Backer; Anna Dominiczak; Maurizio Galderisi; Diederick E Grobbee; Tiny Jaarsma; Paulus Kirchhof; Sverre E Kjeldsen; Stéphane Laurent; Athanasios J Manolis; Peter M Nilsson; Luis Miguel Ruilope; Roland E Schmieder; Per Anton Sirnes; Peter Sleight; Margus Viigimaa; Bernard Waeber; Faiez Zannad; Josep Redon; Anna Dominiczak; Krzysztof Narkiewicz; Peter M Nilsson; Michel Burnier; Margus Viigimaa; Ettore Ambrosioni; Mark Caufield; Antonio Coca; Michael Hecht Olsen; Roland E Schmieder; Costas Tsioufis; Philippe van de Borne; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Cetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Denis L Clement; Antonio Coca; Thierry C Gillebert; Michal Tendera; Enrico Agabiti Rosei; Ettore Ambrosioni; Stefan D Anker; Johann Bauersachs; Jana Brguljan Hitij; Mark Caulfield; Marc De Buyzere; Sabina De Geest; Geneviève Anne Derumeaux; Serap Erdine; Csaba Farsang; Christian Funck-Brentano; Vjekoslav Gerc; Giuseppe Germano; Stephan Gielen; Herman Haller; Arno W Hoes; Jens Jordan; Thomas Kahan; Michel Komajda; Dragan Lovic; Heiko Mahrholdt; Michael Hecht Olsen; Jan Ostergren; Gianfranco Parati; Joep Perk; Jorge Polonia; Bogdan A Popescu; Zeljko Reiner; Lars Rydén; Yuriy Sirenko; Alice Stanton; Harry Struijker-Boudier; Costas Tsioufis; Philippe van de Borne; Charalambos Vlachopoulos; Massimo Volpe; David A Wood Journal: Eur Heart J Date: 2013-06-14 Impact factor: 29.983
Authors: Kathryn Foti; Shakia T Hardy; Alex R Chang; Elizabeth Selvin; Josef Coresh; Paul Muntner Journal: J Hypertens Date: 2022-04-01 Impact factor: 4.844
Authors: Meaghan Lunney; Marinella Ruospo; Patrizia Natale; Robert R Quinn; Paul E Ronksley; Ioannis Konstantinidis; Suetonia C Palmer; Marcello Tonelli; Giovanni Fm Strippoli; Pietro Ravani Journal: Cochrane Database Syst Rev Date: 2020-02-27
Authors: John R Petrie; Steven P Marso; Stephen C Bain; Edward Franek; Stephan Jacob; Luis Masmiquel; Lawrence A Leiter; Martin Haluzik; Ilhan Satman; Mohamed Omar; Marina Shestakova; Luc Van Gaal; Johannes F Mann; Florian M M Baeres; Bernard Zinman; Neil R Poulter Journal: J Hypertens Date: 2016-06 Impact factor: 4.844