Renal Outcomes in High-Risk Hypertensive Patients Treated With an Angiotensin-Converting Enzyme Inhibitor or a Calcium Channel Blocker vs. a Diuretic. A Report From the Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Rahman, Mahboob; Pressel, Sara L.; Davis, Barry R.; Nwachuku, Chuke; Wright, Jackson T.; Barzilay, Joshua I.; Batuman, Vecihi; Eckfeldt, John H.; Farber, Michael A.; Henriquez, Mario; Kopyt, Nelson; Louis, Gail T.; Saklayen, Mohammad G.; Stanford, Carol; Walworth, Candace; Ward, Harry J.; Wiegmann, Thomas

doi:10.1016/j.accreview.2005.08.026

Cited by 75 publications

(99 citation statements)

References 33 publications

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“…90 Participants assigned to amlodipine had a higher baseline GFR than those assigned to chlorthalidone, but rates of development of ESRD did not differ between the groups. 90 However, renal outcomes were not a primary end point in ALLHAT, and no proteinuria data were collected, which may confound interpretation of these results.…”

Section: Clinical Evidence Of Benefits Of Raas Inhibition In Non-diabmentioning

confidence: 88%

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Karalliedde

Viberti

2006

J Hum Hypertens

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The incidence of end-stage renal disease (ESRD) is rising worldwide, accompanied by corresponding increases in the risk of morbidity and mortality. Underlying this trend are increasing rates of hypertension and diabetes mellitus, the two most common causes of ESRD. In addition to the adverse haemodynamic effects of hypertension on the kidney, elevated blood pressure (BP) can activate components of the renin-angiotensinaldosterone system (RAAS), which, in turn, activate mediators of inflammation, oxidative stress, cell growth, and matrix accumulation. Lowering BP reduces the risk of cardiovascular events and renal damage. Accumulating evidence from clinical and laboratory studies suggests that interrupting the RAAS with therapies such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone receptor blockers can interfere with the mechanisms that promote diabetic and non-diabetic renal damage. Moreover, clinical trials of RAAS blockade have demonstrated reductions in microalbuminuria, a predictor of increased cardiorenal risk and overt nephropathy in patients with and without diabetes and/or hypertension. In this way, agents that block the RAAS should be considered the drugs of first choice as they provide enhanced renoprotection compared with other classes of antihypertensive agents such as calcium channel blockers and b-blockers.

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Section: Clinical Evidence Of Benefits Of Raas Inhibition In Non-diabmentioning

confidence: 88%

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Karalliedde

Viberti

2006

J Hum Hypertens

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“…Second, since the incidence of CKD is lower than the incidence of cardiovascular disease and stroke, participants' belief that CKD is the lesser threat is often accurate. 4,[41][42][43][44] For example, the 25% of participants who were 60 years old or older and had no evidence of CKD at baseline may have little risk of developing clinically important CKD. Third, the parent study was designed to identify the effectiveness of patient and provider interventions on blood pressure adherence.…”

Section: Discussionmentioning

confidence: 99%

Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices

et al. 2009

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BACKGROUND: Patients' views of their risk for the development or progression of chronic kidney disease (CKD) are poorly characterized.OBJECTIVE: To assess perceived risk and concern regarding CKD development or progression among high-risk patients seen in primary care, identify predictors of perceptions, and correlate perceptions with adherence to high blood pressure management. DESIGN AND PARTICIPANTS:Cross-sectional study of 195 patients enrolled in a randomized controlled trial on hypertension management in 40 Maryland primary care practices. MEASUREMENTS:We assessed independent predictors (sociodemographics, health literacy, clinical presence of CKD, co-morbid conditions, and health behaviors) of perceived susceptibility (assessed via questionnaire) and adherence (assessed via Hill-Bone blood pressure adherence scale) in multivariable analyses. MAIN RESULTS:In this hypertensive majority African American (63%) population, many participants had uncontrolled blood pressure (44%) or diabetes (42%). Few (20%) felt "very likely" to develop CKD and one third (33%) were "very concerned" about developing CKD. Participants who were female and had low health literacy had lower perceived susceptibility to CKD compared to males and those with higher health literacy. Race and diabetes were also associated with perceived susceptibility. Greater perceived susceptibility was associated with poorer blood pressure management adherence scores.CONCLUSIONS: Many high-risk patients have low perceived susceptibility to CKD. Poor blood pressure therapy adherence scores among those with greatest perceived susceptibility suggest fatalistic attitudes about CKD. If our findings are confirmed in larger studies, interventions targeting patient perceptions of CKD risk and other attitudes associated with these perceptions could impact adherence to therapies and health outcomes.

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“…Among various specific comparisons, the ALLHAT trial (19) was the first to compare the efficacy of these drugs in preventing renal impairment by hypertension. In diabetic patients with moderate baseline loss of glomerular filtration rate (60 to 90 mL/min), the incidence of end-stage renal failure was more than 70% higher in patients treated with amlodipine or lisinopril than in patients treated with chlorthalidone (20). The superiority of chlorthalidone was also demonstrated in patients with diabetes and in patients who developed diabetes during the follow-up (21).…”

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confidence: 54%

The corporate bias and the molding of prescription practices: the case of hypertension

Fuchs

2009

Braz J Med Biol Res

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Drug management of hypertension has been a noticeable example of the influence of the pharmaceutical industry on prescription practices. The worldwide leading brands of blood pressure-lowering agents are angiotensin receptor-blocking agents, although they are considered to be simply substitutes of angiotensin-converting enzyme (ACE) inhibitors. Commercial strategies have been based on the results of clinical trials sponsored by drug companies. Most of them presented distortions in their planning, presentation or interpretation that favored the drugs from the sponsor, i.e., corporate bias. Atenolol, an ineffective blood pressure agent in elderly individuals, was the comparator drug in several trials. In a re-analysis of the INSIGHT trial, deaths appeared to have been counted twice. The LIFE trial appears in the title of more than 120 reproductions of the main and flawed trial, as a massive strategy of scientific marketing. Most guidelines have incorporated the corporate bias from the original studies, and the evidence from better designed studies, such as the ALLHAT trial, have been largely ignored. In trials published recently corporate influences have touched on ethical limits. In the ADVANCE trial, elderly patients with type 2 diabetes and cardiovascular disease or risk factors, allocated to placebo, were not allowed to use diuretic and full doses of an ACE inhibitor, despite the sound evidence of benefit demonstrated in previous trials. As a consequence, they had a 14% higher mortality rate than the participants allocated to the active treatment arm. This reality should be modified immediately, and a greater independence of the academy from the pharmaceutical industry is necessary.

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Renal Outcomes in High-Risk Hypertensive Patients Treated With an Angiotensin-Converting Enzyme Inhibitor or a Calcium Channel Blocker vs. a Diuretic. A Report From the Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Cited by 75 publications

References 33 publications

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices

The corporate bias and the molding of prescription practices: the case of hypertension

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