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 3

Adjusted hazard ratio (95% CI) of morbidity and mortality by the end of posttrial (12-31-2017) period by 3 arms.
Total participants N = 8007In trial participants who received the study trial drugIn trial participants who did not receive the study trial drug
Diuretic = thiazide/thiazide-type (randomized to chlorthalidone in trial: 3637 (45.4))1) any diuretic (1 drug)2) any diuretic plus 1 drug (2 drugs)3) any diuretic plus 2 drugs (3 drugs)4) any diuretic plus ≥3 drugs (4 + drugs)1) no diuretic (on 1 drug)2) no diuretic (on 2 drugs)3) no diuretic (on 3 drugs)4) no diuretic (on 4 + drugs)5) No drugs
Mortality outcomes
All-cause mortality1.00 (ref)1.01 (0.71-1.43)0.93 (0.65-1.31)1.16 (0.82-1.62)1.11 (0.79-1.56)1.17 (0.84-1.64)1.45 (1.03-2.05)1.97 (1.38-2.81)1.12 (0.77-1.62)
CVD mortality1.00 (ref)1.02 (0.60-1.75)0.84 (0.49-1.44)1.16 (0.70-1.95)1.01 (0.59-1.72)1.12 (0.67-1.87)1.66 (0.99-2.77)2.40 (1.42-4.08)0.95 (0.53-1.70)
CHD mortality1.00 (ref)0.90 (0.40-2.01)0.63 (0.28-1.43)1.22 (0.57-2.60)0.83 (0.38-1.84)0.99 (0.46-2.16)1.88 (0.87-4.04)2.82 (1.29-6.15)0.94 (0.40-2.25)
Stroke mortality1.00 (ref)0.81 (0.21-3.16)0.69 (0.17-2.75)1.20 (0.33-4.38)1.44 (0.38-5.43)1.06 (0.30-3.69)1.63 (0.41-6.44)1.41 (0.28-6.96)0.75 (0.15-3.75)
Heart failure mortality1.00 (ref)1.04 (0.12-8.97)1.03 (0.20-5.36)0.69 (0.17-2.80)0.74 (0.14-3.91)0.76 (0.17-3.35)0.77 (0.17-3.44)1.97 (0.37-10.42)0.60 (0.06-5.71)
Other CVD mortality1.00 (ref)1.67 (0.56-4.96)1.46 (0.48-4.47)1.33 (0.45-3.96)1.37 (0.45-4.20)1.68 (0.59-4.77)2.41 (0.84-6.98)3.38 (1.14-10.05)1.65 (0.48-5.64)
Non-CVD mortality1.00 (ref)1.04 (0.65-1.66)1.00 (0.63-1.58)1.17 (0.74-1.84)1.21 (0.77-1.90)1.19 (0.76-1.87)1.29 (0.81-2.05)1.68 (1.04-2.72)1.27 (0.78-2.07)
Cancer1.00 (ref)1.79 (0.62-5.16)1.35 (0.47-3.90)1.58 (0.54-4.58)1.51 (0.52-4.40)1.77 (0.62-5.06)1.98 (0.68-5.81)2.45 (0.76-7.84)1.76 (0.56-5.51)
Kidney disease1.00 (ref)− (-)− (-)− (-)− (-)− ( )− (-)− (-)− (-)
Accident/suicide/homicide1.00 (ref)− (-)0.87 (0.09-8.63)1.00 (0.10-10.51)1.38 (0.16-11.84)0.99 (0.09-10.36)0.99 (0.08-12.78)1.91 (0.19-19.59)0.33 (0.01-11.19)
Other non-CVD disease1.00 (ref)0.81 (0.47-1.40)0.87 (0.52-1.47)1.00 (0.59-1.70)1.10 (0.66-1.84)1.00 (0.60-1.67)1.05 (0.61-1.80)1.45 (0.83-2.52)1.13 (0.65-1.99)
Combined fatal and nonfatal hospitalized events
CVD1.00 (ref)0.79 (0.50-1.25)1.02 (0.66-1.58)1.15 (0.75-1.77)0.98 (0.63-1.53)1.05 (0.68-1.63)1.60 (1.04-2.49)2.44 (1.57-3.81)0.82 (0.50-1.36)
CHD1.00 (ref)0.88 (0.43-1.80)1.01 (0.51-2.03)1.43 (0.73-2.82)1.02 (0.51-2.03)1.06 (0.53-2.10)1.93 (0.98-3.80)2.96 (1.48-5.89)0.94 (0.44-2.03)
Heart failure1.00 (ref)0.72 (0.39-1.32)1.24 (0.71-2.19)1.32 (0.76-2.28)1.05 (0.59-1.87)1.23 (0.71-2.15)1.94 (1.11-3.38)3.09 (1.77-5.40)0.91 (0.48-1.75)
Stroke1.00 (ref)1.41 (0.58-3.43)1.07 (0.45-2.57)1.38 (0.57-3.32)1.30 (0.52-3.20)1.51 (0.64-3.56)1.42 (0.58-3.48)1.93 (0.77-4.84)1.15 (0.43-3.11)
Cancer1.00 (ref)1.01 (0.51-1.98)0.81 (0.42-1.58)1.01 (0.52-1.96)0.73 (0.37-1.43)0.96 (0.50-1.86)1.24 (0.63-2.44)1.19 (0.58-2.45)0.97 (0.46-2.03)
Kidney disease/ESRD1.00 (ref)0.81 (0.08-7.89)1.36 (0.16-11.59)3.07 (0.40-23.31)1.58 (0.19-13.16)3.07 (0.40-23.29)2.67 (0.33-21.50)4.91 (0.63-38.06)3.25 (0.17-63.50)
Calcium channel blocker (CCB) (randomized to amlodipine in trial: 2189 (27.3))1) any CCB (1 drug)2) any CCB plus 1 drug (2 drugs)3) any CCB plus 2 drugs (3 drugs)4) any CCB plus ≥3 drugs (4 + drugs)1) no CCB (on 1 drug)2) no CCB (on 2 drugs)3) no CCB (on 3 drugs)4) no CCB (on 4 + drugs)5) No Drugs
Mortality outcomes
All-cause mortality1.00 (ref)0.92 (0.67-1.27)1.04 (0.76-1.42)1.23 (0.91-1.66)0.97 (0.70-1.35)0.97 (0.71-1.32)1.15 (0.83-1.60)1.76 (1.16-2.67)1.06 (0.71-1.56)
CVD mortality1.00 (ref)0.78 (0.45-1.34)1.36 (0.82-2.24)1.36 (0.83-2.23)1.05 (0.61-1.78)0.97 (0.58-1.61)1.48 (0.89-2.47)2.41 (1.23-4.73)0.99 (0.53-1.88)
CHD mortality1.00 (ref)2.49 (0.65-9.49)4.54 (1.34-15.40)4.97 (1.50-16.48)3.71 (1.05-13.04)2.90 (0.85-9.86)5.03 (1.39-18.25)8.87 (2.11-37.23)4.42 (1.09-17.95)
Stroke mortality1.00 (ref)1.81 (0.14-22.57)3.77 (0.47-30.42)3.35 (0.41-27.26)2.18 (0.20-24.06)3.39 (0.42-27.53)4.34 (0.50-37.46)2.80 (0.08-96.99)7.12 (0.59-85.51)
Heart failure mortality1.00 (ref)1.64 (0.08-34.42)6.41 (0.73-56.17)5.54 (0.69-44.29)3.00 (0.28-32.28)1.17 (0.10-14.23)7.47 (0.71-78.01)70.21 (4.06-1213.94)− (-)
Other CVD mortality1.00 (ref)0.48 (0.23-0.97)0.43 (0.21-0.87)0.36 (0.18-0.72)0.35 (0.16-0.75)0.39 (0.20-0.77)0.62 (0.31-1.24)0.37 (0.12-1.20)0.30 (0.10-0.86)
Non-CVD mortality1.00 (ref)1.00 (0.67-1.49)0.84 (0.56-1.26)1.15 (0.78-1.68)0.95 (0.63-1.44)0.95 (0.65-1.41)0.95 (0.62-1.45)1.42 (0.82-2.44)1.06 (0.64-1.74)
Cancer1.00 (ref)1.09 (0.48-2.47)0.66 (0.29-1.53)0.94 (0.43-2.09)1.03 (0.43-2.47)0.73 (0.33-1.60)0.77 (0.31-1.90)1.23 (0.39-3.88)0.76 (0.23-2.46)
Kidney disease1.00 (ref)0.49 (0.10-2.47)0.17 (0.03-1.16)0.74 (0.20-2.78)0.93 (0.20-4.38)0.29 (0.05-1.71)0.72 (0.11-4.50)1.01 (0.18-5.74)− (-)
Accident/suicide/homicide1.00 (ref)− (-)0.39 (0.03-5.14)0.83 (0.08-8.40)0.73 (0.06-9.72)0.54 (0.07-4.41)− (-)− (-)− (-)
Other non-CVD disease1.00 (ref)1.09 (0.65-1.82)1.02 (0.61-1.70)1.35 (0.83-2.19)0.93 (0.55-1.58)1.17 (0.71-1.91)1.20 (0.70-2.05)1.84 (0.92-3.68)1.55 (0.84-2.85)
Combined fatal and nonfatal hospitalized events
CVD1.00 (ref)1.23 (0.74-2.04)1.76 (1.10-2.83)2.21 (1.39-3.52)1.42 (0.86-2.35)1.37 (0.84-2.22)1.93 (1.17-3.17)2.77 (1.53-5.04)1.58 (0.85-2.93)
CHD1.00 (ref)1.90 (0.78-4.61)2.91 (1.30-6.51)2.94 (1.32-6.53)1.89 (0.80-4.46)1.79 (0.78-4.08)2.46 (1.03-5.85)5.60 (1.92-16.31)2.80 (1.09-7.22)
Heart failure1.00 (ref)0.86 (0.50-1.49)1.36 (0.83-2.23)1.78 (1.10-2.87)0.86 (0.50-1.50)1.06 (0.63-1.76)1.76 (1.05-2.95)3.06 (1.66-5.67)1.02 (0.51-2.04)
Stroke1.00 (ref)2.09 (0.69-6.28)2.51 (0.88-7.18)2.58 (0.90-7.37)2.37 (0.79-7.13)3.23 (1.14-9.17)3.21 (1.04-9.91)3.82 (0.90-16.14)2.74 (0.63-11.91)
Cancer1.00 (ref)1.14 (0.57-2.28)0.80 (0.41-1.56)1.08 (0.57-2.05)0.94 (0.47-1.89)0.87 (0.46-1.68)0.79 (0.38-1.64)1.70 (0.66-4.37)0.81 (0.33-1.96)
Kidney disease/ESRD1.00 (ref)0.24 (0.07-0.89)0.56 (0.20-1.53)0.89 (0.36-2.21)0.59 (0.19-1.78)0.44 (0.16-1.25)0.32 (0.08-1.25)0.84 (0.25-2.80)0.00 (0.00-1.17)
Angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blockers (ARB) (randomized to lisinopril in trial: 2181 (27.2))1) any ACE/ARB (1 drug)2) any ACE/ARB plus 1 drug (2 drugs)3) any ACE/ARB plus 2 drugs (3 drugs)4) any ACE/ARB plus ≥3 drugs (4 + drugs)1) no ACE/ARB (on 1 drug)2) no ACE/ARB (on 2 drugs)3) no ACE/ARB (on 3 drugs)4) no ACE/ARB (on 4 + drugs)5) No Drugs
Mortality outcomes
All-cause mortality1.00 (ref)0.85 (0.63–1.13)1.11 (0.85–1.46)1.21 (0.91–1.62)1.06 (0.75–1.50)1.05 (0.75–1.46)1.01 (0.68–1.50)0.85 (0.48–1.48)0.97 (0.67–1.40)
CVD mortality1.00 (ref)0.76 (0.47–1.23)1.22 (0.78–1.91)1.67 (1.05–2.64)1.14 (0.66–1.98)1.24 (0.73–2.10)0.84 (0.43–1.64)0.59 (0.21–1.62)0.92 (0.49–1.72)
CHD mortality1.00 (ref)0.57 (0.28–1.17)1.11 (0.58–2.11)1.44 (0.74–2.79)1.33 (0.61–2.88)0.83 (0.37–1.85)1.45 (0.62–3.38)1.25 (0.29–5.44)0.59 (0.22–1.59)
Stroke mortality1.00 (ref)0.93 (0.30–2.90)0.55 (0.17–1.75)1.21 (0.41–3.53)1.14 (0.20–6.33)1.87 (0.57–6.08)− (-)− (-)0.34 (0.06–1.78)
Heart failure mortality1.00 (ref)1.05 (0.19–5.85)1.64 (0.35–7.74)3.27 (0.67–15.95)3.59 (0.02–522.24)7.74 (0.97–61.48)− (-)1.21 (0.01–130.04)− (-)
Other CVD mortality1.00 (ref)0.87 (0.33–2.29)1.83 (0.75–4.47)2.13 (0.84–5.43)1.16 (0.40–3.39)0.71 (0.21–2.38)0.42 (0.09–2.00)0.43 (0.05–3.53)2.38 (0.68–8.29)
Non-CVD mortality1.00 (ref)0.90 (0.63–1.30)1.05 (0.74–1.49)0.93 (0.64–1.37)1.01 (0.65–1.58)0.94 (0.60–1.45)1.11 (0.68–1.80)1.02 (0.52–1.99)0.99 (0.63–1.56)
Cancer1.00 (ref)0.62 (0.30–1.27)0.89 (0.46–1.72)0.49 (0.23–1.05)0.91 (0.40–2.08)0.55 (0.23–1.28)0.73 (0.26–2.04)0.63 (0.15–2.55)1.34 (0.60–2.99)
Kidney disease1.00 (ref)1.92 (0.21–17.40)1.00 (0.10–9.65)5.78 (0.68–49.00)7.22 (0.64–81.59)3.52 (0.32–39.20)0.80 (0.01–68.65)− (-)6.01 (0.40-–0.29)
Accident/suicide/homicide1.00 (ref)1.37 (0.26–7.25)1.12 (0.19–6.43)1.02 (0.12–8.86)1.39 (0.11–17.16)3.26 (0.29–36.35)− (-)− (-)− (-)
Other non-CVD disease1.00 (ref)0.97 (0.62–1.52)1.18 (0.76–1.82)0.98 (0.61–1.57)0.88 (0.50–1.57)0.97 (0.55–1.70)1.34 (0.74–2.42)0.91 (0.37–2.19)0.70 (0.38–1.29)
Combined fatal and nonfatal hospitalized events
CVD1.00 (ref)0.84 (0.56–1.27)1.43 (0.98–2.09)1.78 (1.19–2.64)0.91 (0.56–1.49)1.22 (0.77–1.94)1.05 (0.61–1.81)0.81 (0.36–1.82)0.69 (0.38–1.24)
CHD1.00 (ref)0.59 (0.33–1.06)1.14 (0.67–1.93)1.27 (0.73–2.22)0.82 (0.41–1.62)0.91 (0.47–1.74)1.00 (0.48–2.10)0.60 (0.17–2.06)0.44 (0.18–1.07)
Heart failure1.00 (ref)1.17 (0.70–1.95)1.79 (1.10–2.89)2.68 (1.64–4.41)0.99 (0.52–1.90)1.86 (1.04–3.31)1.36 (0.69–2.66)1.01 (0.38–2.66)0.78 (0.36–1.69)
Stroke1.00 (ref)0.80 (0.40–1.60)1.06 (0.56–2.00)1.05 (0.53–2.06)0.73 (0.32–1.69)1.01 (0.47–2.20)0.30 (0.09–1.04)0.36 (0.09–1.53)0.89 (0.35–2.25)
Cancer1.00 (ref)0.64 (0.35–1.18)0.90 (0.52–1.56)0.68 (0.37–1.23)0.86 (0.43–1.75)0.74 (0.37–1.48)0.81 (0.35–1.88)0.63 (0.19–2.06)1.12 (0.55–2.31)
Kidney disease/ESRD1.00 (ref)3.62 (0.44–29.84)3.51 (0.44–27.92)8.80 (1.17–66.24)6.99 (0.78–62.32)6.15 (0.57–66.57)9.88 (0.44–220.67)629.84 (3.28–120934.30)13.46 (1.37–132.69)
Likelihood did not converge due to the small number of events. Baseline covariates in the adjusted hazard ratio models include age (years), race (black/non-black), gender, education (years), current smoking status, BMI, entry criterion HDL<35, LDL, GFR, history of diabetes, antihypertensive treatment, on pravastatin, and SBP. In-trial covariate included final SBP.