Abstract 2734: Heart Failure with Preserved and Impaired Left Ventricular Systolic Function in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
Purpose: Heart failure (HF) developing in hypertensive patients may be associated with preserved (ejection fraction [EF]≥ 50%) or impaired (EF<50%) left ventricular systolic function (LVSF). ALLHAT, in 42,418 high-risk hypertensive patients randomized to chlorthalidone, amlodipine, lisinopril, or doxazosin, provided an opportunity to examine the relative advantage of these treatments for the occurrence of hospitalized (fatal or non-fatal) HF with preserved or impaired LVSF.
Methods: To validate HF outcomes, all available hospitalized HF events were centrally reviewed using a pre-specified algorithm based on ALLHAT criteria (at least one sign and one symptom for HF). EF estimate by contrast ventriculography, echocardiography or radionuclide study was available at the time of event in 910 (66.6%) of 1367 first hospitalized events meeting ALLHAT criteria for HF. Multinomial logistic models were used to examine treatment differences for HF (overall and by preserved or impaired LVSF).
Results: Of those with EF data, 45.6% had preserved LVSF and 54.4% had impaired LVSF.
Conclusions: Using validated outcomes, chlorthalidone-based treatment significantly reduced the overall risk of HF and HF presenting with preserved LVSF compared with amlodipine-, lisinopril- or doxazosin-based treatment. It also reduced the risk of HF presenting with impaired LVSF compared with amlodipine and doxazosin, but to a lesser degree. Chlorthalidone was similar to lisinopril in reducing HF presenting with impaired LVSF.