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Author Notes:

Corresponding Author: Jose-Miguel Yamal, PhD, Coordinating Center for Clinical Trials, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, Tel : 713-500-9566, Fax: 713-500-9530, Jose-Miguel.Yamal@uth.tmc.edu.

We thank Dr. Ellen Breckenridge for her editorial assistance, Mohammad L. Rahman for assistance with the tables, and Glenn W. Schreyer for his programming help.

The National Heart, Lung, and Blood Institute was involved in all aspects other than direct operations of the study centers. This included collection, analysis, and interpretation of the data plus the decision to submit the manuscript for publication.

Pfizer Inc., AstraZeneca, and Bristol-Myers Squibb had no role in the design and conduct of the study, the collection, analysis, and interpretation of the data; or the preparation or approval of the manuscript.

Barry Davis, Sara Pressel, and Jose-Miguel Yamal had full access to all the data in the study.

Barry Davis, Director of the Clinical Trials Center, takes responsibility for the integrity of the data and the accuracy of the data analysis.

ALLHAT Steering Committee made the final decision to submit the paper for publication.

Drs. Reisin, Graves, Yamal, Barzilay, Einhorn, Dart, Retta, and Saklayen, and Ms. Pressel have no conflicts to report.

Dr. Davis has received honoraria from Takeda and Amgen.


Research Funding:

National Heart, Lung, and Blood Institute contracts NO1-HC-35130 and HHSN268201100036C supported this study.

ALLHAT investigators acknowledge medications contributed by Pfizer, Inc., (amlodipine and doxazosin), AstraZeneca (atenolol and lisinopril), and Bristol-Myers Squibb (pravastatin) and financial support provided by Pfizer, Inc.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Peripheral Vascular Disease
  • Cardiovascular System & Cardiology
  • blood pressure control
  • hypertension
  • obesity
  • overweight
  • RISK

Blood pressure control and cardiovascular outcomes in normal-weight, overweight, and obese hypertensive patients treated with three different antihypertensives in ALLHAT


Journal Title:

Journal of Hypertension


Volume 32, Number 7


, Pages 1503-1513

Type of Work:

Article | Post-print: After Peer Review


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 angiotensinconverting enzyme inhibitor, on BP control and cardiovascular outcomes in a hypertensive cohort stratified by baseline BMI [kg/m2; 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. © 2014 Wolters Kluwer Health.

Copyright information:

© Lippincott Williams & Wilkins

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