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Choice of antihypertensive drug not linked to adverse outcomes in older adults

15 May 2019

The choice of blood pressure-lowering agent in the treatment of older adults does not appear to exert any effects on the risk of fall, syncope or orthostatic hypertension (OH), a study has found.

Researchers used data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial to examine whether chlorthalidone and atenolol were associated with higher risk of adverse outcomes as compared with amlodipine or lisinopril.

The analysis included 23,964 ALLHAT participants (mean age, 70.4 years; 43 percent female; 31 percent Black) who were receiving treatment with chlorthalidone, atenolol, amlodipine or lisinopril. Over a mean follow-up of 4.9 years, there were 267 fall, 755 syncope, 249 OH and 1,157 composite events with no significant differences in the cumulative incidence across treatment arms.

Compared with chlorthalidone, amlodipine and lisinopril did not contribute to an increased risk of falls (hazard ratio [HR], 1.36; 95 percent CI, 0.90–2.05 and HR, 0.80; 0.47–1.36, respectively), syncope (HR, 0.96; 0.77–1.21 and HR, 1.07; 0.85–1.34, respectively), OH (HR, 0.98; 0.66–1.45 and HR, 1.24; 0.87–1.76, respectively) or the composite outcome (HR, 1.01; 0.84–1.21 and HR, 1.07; 0.92–1.22, respectively).

Likewise, use of atenolol was not associated with any of the three individual or composite outcome.

The present data should simplify the choice of initiating antihypertensive therapy in older adults, according to researchers.

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