ALLHAT-ACEI

Is lisinopril superior to chlorthalidone in high-risk patients with HTN?

Study design

Population

24309 patients (11358 female, 12951 male)
Inclusion criteria: patients ≥ 55 years of age with HTN and at least 1 other coronary heart disease risk factor
Key exclusion criteria: history of hospitalized or treated symptomatic HF and/or known LV ejection fraction <35%

Interventions

N=9054 lisinopril (a dose of 10-40 mg/day)
N=15255 chlorthalidone (a dose of 12.5-25 mg/day)

Primary outcome

No significant difference in the rate of fatal coronary heart disease or nonfatal myocardial infarction within 6 years (11.4% vs. 11.5%; RR 0.99, 99% CI 0.91 to 1.08)

Secondary outcomes

No significant difference in the rate of death from all causes within 6 years (17.2% vs. 17.3%; RR 1, 95% CI 0.94 to 1.08)
No significant difference in the rate of coronary heart disease within 6 years (20.8% vs. 19.9%; RR 1.05, 95% CI 0.98 to 1.11)
Significant increase in the rate of stroke within 6 years (6.3% vs. 5.6%; RR 1.15, 95% Cl 1.02 to 1.3)

Safety outcomes

No significant difference in hospitalization for gastrointestinal bleeding.

Conclusion

In patients ≥ 55 years of age with HTN and at least 1 other coronary heart disease risk factor, lisinopril was not superior to chlorthalidone with respect to the rate of fatal coronary heart disease or nonfatal myocardial infarction within 6 years.