International Journal of Hypertension

Research Article

Effects of Posttrial Antihypertensive Drugs on Morbidity and Mortality: Findings from 15-Year Passive Follow-Up after ALLHAT Ended

Table 1

Patterns of posttrial antihypertensive drug utilization from Medicare Part-D drug coverage as of 2007.


	N (%) receiving antihypertensive druga in 2007–2017 by initial ALLHAT 3 arms
	Chlorthalidone	Amlodipine	Lisinopril	Total

Antihypertensive drugs in 2007 as baseline from 1^st year enrolled in CMS/Part-D data	3420 (94)	2055 (93.9)	2062 (94.5)	7537 (94.1)
Aldosterone antagonists^†	187 (5.1)	87 (4.0)	101 (4.6)	375 (4.7)
Alpha 1 adrenergic receptor agonist (selective; α-blocker)	201 (5.5)	124 (5.7)	128 (5.9)	453 (5.7)
Angiotensin-converting enzyme (ACE) inhibitor	1717 (47.2)	1024 (46.8)	1129 (51.8)	3870 (48.3)
Angiotensin II receptor blockers (ARB)	983 (27.0)	602 (27.5)	592 (27.1)	2177 (27.2)
Total ACE inhibitor + ARB	2443 (67.2)	1457 (66.6)	1562 (71.6)	5462 (68.2)
Arteriolar vasodilators	177 (4.9)	112 (5.1)	153 (7.0)	442 (5.5)
Autonomic ganglionic vasodilators	0 (0)	0 (0)	0 (0)	0 (0)
Beta adrenergic blockers (β-blockers)	1915 (52.7)	1099 (50.2)	1121 (51.4)	4135 (51.6)
Calcium channel blocker (CCB)-dihydropyridine	1316 (36.2)	956 (43.7)	804 (36.9)	3076 (38.4)
Calcium channel blocker (CCB)-nondihydropyridine	345 (9.5)	191 (8.7)	193 (8.8)	729 (9.1)
Total CCB-dihydropyridine + nondihydropyridine	1602 (44.0)	1109 (50.7)	968 (44.4)	3679 (45.9)
Central alpha 2 adrenergic agonists	330 (9.1)	185 (8.5)	219 (10.0)	734 (9.2)
Diuretics: thiazide	1305 (35.9)	805 (36.8)	797 (36.5)	2907 (36.3)
Diuretics: thiazide-type	348 (9.6)	98 (4.5)	97 (4.4)	543 (6.8)
Diuretics: thiazide or thiazide-type	1613 (44.3)	890 (40.7)	877 (40.2)	3380 (42.2)
Diuretics: loop	1095 (30.1)	652 (29.8)	682 (31.3)	2429 (30.3)
Diuretics: potassium-sparing^†	189 (5.2)	90 (4.1)	92 (4.2)	371 (4.6)
Total-all diuretics	2470 (67.9)	1371 (62.6)	1386 (63.5)	5227 (65.3)
Peripheral adrenergic neuron antagonist^†	6 (0.2)	2 (0.1)	3 (0.1)	11 (0.1)
Renin inhibitors	11 (0.3)	4 (0.2)	4 (0.2)	19 (0.2)
No drugs	217 (6.0)	134 (6.1)	119 (5.5)	470 (5.9)
Total	3637 (100)	2189 (100)	2181 (100)	8007 (100)
Antihypertensive drugs in 2008–2010 (baseline: enrolled CMS/Part-D 2007, continued through 2008–2010)	3214 (97.4)	1939 (97.1)	1920 (97.6)	7073 (97.4)
Aldosterone antagonists^†	271 (8.2)	144 (7.2)	126 (6.4)	541 (7.4)
Alpha 1 adrenergic receptor agonist (selective; α-blocker)	293 (8.9)	171 (8.6)	185 (9.4)	649 (8.9)
Angiotensin-converting enzyme (ACE) inhibitor	1968 (59.7)	1184 (59.3)	1221 (62.1)	4373 (60.2)
Angiotensin II receptor blockers (ARB)	1142 (34.6)	701 (35.1)	679 (34.5)	2522 (34.7)
Total ACE inhibitor + ARB	2569 (77.9)	1570 (78.6)	1587 (80.7)	5726 (78.8)
Arteriolar vasodilators	282 (8.5)	163 (8.2)	202 (10.3)	647 (8.9)
Autonomic ganglionic vasodilators	0 (0)	0 (0)	0 (0)	0 (0)
Beta adrenergic blockers (β-blockers)	2093 (63.4)	1224 (61.3)	1237 (62.9)	4554 (62.7)
Calcium channel blocker (CCB)-dihydropyridine	1621 (49.1)	1113 (55.7)	973 (49.5)	3707 (51.0)
Calcium channel blocker (CCB)-nondihydropyridine	384 (11.6)	211 (10.6)	227 (11.5)	822 (11.3)
Total CCB-dihydropyridine + nondihydropyridine	1850 (56.1)	1245 (62.3)	1111 (56.5)	4206 (57.9)
Central alpha 2 adrenergic agonists	395 (12.0)	241 (12.1)	279 (14.2)	915 (12.6)
Diuretics: thiazide	1452 (44.0)	902 (45.2)	895 (45.5)	3249 (44.7)
Diuretics: thiazide-type	410 (12.4)	131 (6.6)	154 (7.8)	695 (9.6)
Diuretics: thiazide or thiazide-type	1757 (53.3)	998 (50.0)	1000 (50.8)	3755 (51.7)
Diuretics: loop	1393 (42.2)	806 (40.4)	806 (41.0)	3005 (41.4)
Diuretics: potassium-sparing^†	195 (5.9)	102 (5.1)	99 (5.0)	396 (5.5)
Total-all diuretics	2572 (78.0)	1455 (72.9)	1458 (74.1)	5485 (75.5)
Peripheral adrenergic neuron antagonist^†	7 (0.2)	3 (0.2)	3 (0.2)	13 (0.2)
Renin inhibitors	51 (1.5)	25 (1.3)	23 (1.2)	99 (1.4)
No drugs	85 (2.6)	58 (2.9)	47 (2.4)	190 (2.6)
Total	3299 (100)	1997 (100)	1967 (100)	7263 (100)

Antihypertensive drugs in 2011–2013 (baseline: enrolled CMS/Part-D 2007, continued through 2010 to 2011–2013)	2376 (97.7)	1449 (96.7)	1412 (97.5)	5237 (97.3)
Aldosterone antagonists^†	192 (7.9)	115 (7.7)	103 (7.1)	410 (7.6)
Alpha 1 adrenergic receptor agonist (selective; α-blocker)	207 (8.5)	123 (8.2)	131 (9.0)	461 (8.6)
Angiotensin-converting enzyme (ACE) inhibitor	1298 (53.3)	768 (51.2)	813 (56.1)	2879 (53.5)
Angiotensin II receptor blockers (ARB)	926 (38.1)	537 (35.8)	546 (37.7)	2009 (37.3)
Total ACE inhibitor + ARB	1898 (78.0)	1126 (75.1)	1180 (81.5)	4204 (78.1)
Arteriolar vasodilators	278 (11.4)	160 (10.7)	191 (13.2)	629 (11.7)
Autonomic ganglionic vasodilators	0 (0)	0 (0)	0 (0)	0 (0)
Beta adrenergic blockers (β-blockers)	1570 (64.5)	927 (61.8)	934 (64.5)	3431 (63.8)
Calcium channel blocker (CCB)-dihydropyridine	1247 (51.3)	820 (54.7)	767 (53.0)	2834 (52.7)
Calcium channel blocker-nondihydropyridine	249 (10.2)	144 (9.6)	147 (10.2)	540 (10.0)
Total CCB–dihydropyridine + nondihydropyridine	1414 (58.1)	912 (60.8)	869 (60.0)	3195 (59.4)
Central alpha 2 adrenergic agonists	264 (10.9)	159 (10.6)	172 (11.9)	595 (11.1)
Diuretics: thiazide	1005 (41.3)	602 (40.2)	593 (41.0)	2200 (40.9)
Diuretics: thiazide-type	276 (11.3)	103 (6.9)	106 (7.3)	485 (9.0)
Diuretics: thiazide or thiazide-type	1206 (49.6)	672 (44.8)	666 (46.0)	2544 (47.3)
Diuretics: loop	1039 (42.7)	638 (42.6)	602 (41.6)	2279 (42.4)
Diuretics: potassium-sparing^†	111 (4.6)	67 (4.5)	57 (3.9)	235 (4.4)
Total-all diuretics	1841 (75.7)	1071 (71.4)	1033 (71.3)	3945 (73.3)
Peripheral adrenergic neuron antagonist^†	2 (0.1)	2 (0.1)	0 (0)	4 (0.1)
Renin inhibitors	36 (1.5)	18 (1.2)	15 (1.0)	69 (1.3)
No drugs	57 (2.3)	50 (3.3)	36 (2.5)	143 (2.7)
Total	2433 (100)	1499 (100)	1448 (100)	5380 (100)

Antihypertensive drugs in 2014–2017 (baseline: enrolled CMS/Part-D 2007, continued through 2013 into 2014–2017)	1728 (97.9)	1038 (97.1)	1017 (97)	3783 (97.4)
Aldosterone antagonists^†	173 (9.8)	107 (10.0)	96 (9.2)	376 (9.7)
Alpha 1 adrenergic receptor agonist (selective; α-blocker)	137 (7.8)	80 (7.5)	93 (8.9)	310 (8.0)
Angiotensin-converting enzyme (ACE) inhibitor	819 (46.4)	487 (45.6)	492 (46.9)	1798 (46.3)
Angiotensin II receptor blockers (ARB)	716 (40.6)	424 (39.7)	432 (41.2)	1572 (40.5)
Total ACE inhibitor + ARB	1349 (76.4)	793 (74.2)	819 (78.1)	2961 (76.3)
Arteriolar vasodilators	248 (14.1)	156 (14.6)	164 (15.6)	568 (14.6)
Autonomic ganglionic vasodilators	0 (0)	0 (0)	0 (0)	0 (0)
Beta adrenergic blockers (β-blockers)	1172 (66.4)	706 (66.0)	694 (66.2)	2572 (66.3)
Calcium channel blocker (CCB)-dihydropyridine	960 (54.4)	629 (58.8)	588 (56.1)	2177 (56.1)
Calcium channel blocker (CCB)-nondihydropyridine	189 (10.7)	84 (7.9)	102 (9.7)	375 (9.7)
Total CCB-dihydropyridine + nondihydropyridine	1071 (60.7)	684 (64.0)	654 (62.4)	2409 (62.1)
Central alpha 2 adrenergic agonists	174 (9.9)	107 (10.0)	101 (9.6)	382 (9.8)
Diuretics: thiazide	659 (37.3)	395 (37.0)	389 (37.1)	1443 (37.2)
Diuretics: thiazide-type	195 (11.0)	89 (8.3)	84 (8.0)	368 (9.5)
Diuretics: thiazide or thiazide-type	804 (45.6)	456 (42.7)	444 (42.4)	1704 (43.9)
Diuretics: loop	816 (46.2)	511 (47.8)	509 (48.6)	1836 (47.3)
Diuretics: potassium-sparing^†	58 (3.3)	37 (3.5)	29 (2.8)	124 (3.2)
Total-all diuretics	1328 (75.2)	769 (71.9)	762 (72.7)	2859 (73.6)
Peripheral adrenergic neuron antagonist^†	0 (0)	0 (0)	0 (0)	0 (0)
Renin inhibitors	3 (0.2)	0 (0)	5 (0.5)	8 (0.2)
No drugs	37 (2.1)	31 (2.9)	31 (3.0)	99 (2.6)
Total	1765 (100)	1069 (100)	1048 (100)	3882 (100)

Total-all diuretics include aldosterone antagonists; diuretics include thiazide/thiazide-type/loop/potassium-sparing. ^†Not used alone/used in combination for chronic hypertension treatment.