Hypertension Landmark Trials Flashcards
ALLHAT
Population: 55 years or older with hypertension and at least 1 other CV risk factor
Treatment: randomly received thiazide, amlodipine, or lisinopril
Primary outcome: Looking for effects on combined fatal CHD or non-fatal MI
Results: No differences seen in primary outcome or all-cause mortality
Summary: This is why ACEi, ARB, and thiazide diuretic are first line treatment
ONTARGET
Population: patients with atherosclerotic vascular disease or diabetes and end-organ damage
Treatment: randomized to receive telmisartan, ramipril, or both
Primary outcome: composite of dialysis, renal transplant, doubling of SCr, or death
Result: Urine albumin was decreased more with telmisartan and combo therapy. They both have similar outcomes in regards to renal protection
Summary: Reason why ACEi or ARB should be given in patient with DM
RENAAL
Population: patients with type 2 DM and nephropathy
Treatment: randomly receive losartan or placebo plus standard antihypertensive therapy (no ACE-I or ARB)
Primary outcome: composite doubling of SCr, ESRD, or death
Summary: ARBs are effective for treating patients with type 2 DM and nephropathy though they haven’t been shown to reduce mortality
AASK
Population: African American patients with HTN and renal disease
Treatment: randomly receive metoprolol, ramipril, or amlodipine
Results: 22% reduction in the composite outcome of 50% reduction in GFR, ESRD, or death with ramipril compared to metoprolol or amlodipine
Summary: ACE-I are more effective at providing renal protection than beta-blockers or CCBs
PROGRESS
Population: patients with history of stroke of TIA
Treatment: randomly received perindopril plus a diuretic or a placebo
Primary outcome: incidence of stroke (fatal or non-fatal)
Summary: ACE-I plus a diuretic for secondary stroke prevention
USPSTF
Population: adults age 50-69 with 10-year CV risk of at least 10%
Summary: adults aged 50-69 with a 10-year CV risk of at least 10% should use aspirin for at least 10 years, but only if their blood pressure is controlled. If not, it increases the risk of hemorrhagic stroke.
KDIGO
Recommends ACE/ARB for all patients with UACR >30mg/g creatinine
