Do the SBP differences between the lisinopril and chlorthalidone arms explain the differences in CVD - PowerPoint PPT Presentation

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Do the SBP differences between the lisinopril and chlorthalidone arms explain the differences in CVD

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... the SBP differences between the lisinopril and chlorthalidone arms explain the ... BP differences: lisinopril versus chlorthalidone (continued) ... – PowerPoint PPT presentation

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Title: Do the SBP differences between the lisinopril and chlorthalidone arms explain the differences in CVD


1
Do the SBP differences between the lisinopril and
chlorthalidone arms explain the differences in
CVD outcomes?
2
BP differences lisinopril versus chlorthalidone
  • Mean follow-up SBP for L vs. C
  • 2 mm Hg higher all participants
  • 4 mm Hg higher Black participants
  • Adjustment for follow-up SBP/DBP as
    time-dependent covariates in a Cox regression
    model slightly reduced the relative risks but
    they remained statistically significant
  • Stroke (1.15 ? 1.12) HF (1.20 ? 1.17), overall
  • Stroke (1.40 ? 1.35) HF (1.32 ? 1.26), for
    Blacks

3
BP differences lisinopril versus chlorthalidone
(continued)
  • Prospective observational studies predict that 2
    mm Hg difference ? 9 higher stroke mortality
    6 higher HF mortality, versus 15 19 higher
    risk (fatal nonfatal events) observed in ALLHAT
  • Based on same data, 4 mm Hg difference in blacks
    would predict 19 higher stroke mortality 14
    higher HF mortality, versus 40 32 higher risk
    (fatal nonfatal events) in ALLHAT
  • Prospective studies collaboration. Lancet
    20023601903.

4
BP differences lisinopril versus chlorthalidone
(continued)
  • Although application of epidemiologic adjustments
    and extrapolations have limitations, seems
    unlikely that BP differences explain total
    effects.
  • ALLHAT will also conduct a meta-regression
    analysis of BP and CVD endpoints, with clinics (1
    or more) as unit of analysis. This will reduce BP
    measurement error.

5
BP differences Future analyses
  • Divide ALLHAT into a number of large or
    mega-clinics, i.e. small clinics combined into
    mega-clinics.
  • Within each mega-clinic compute a) mean follow-up
    SBP difference between diuretic and other
    treatment arm, and b) log hazard ratio (for a
    given endpoint) using Cox model.
  • Do a weighted regression of log hazard ratios
    against follow-up SBP differences.
  • A markedly non-zero intercept indicates drug
    treatment effect is not entirely explained by
    SBP differences.
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