Cost-effectiveness of Chlorthalidone, Amlodipine, and Lisinopril as First-step Treatment for Patients with Hypertension: An Analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Heidenreich, Paul A.; Davis, Barry R.; Cutler, Jeffrey A.; Furberg, Curt D.; Lairson, David R.; Shlipak, Michael G.; Pressel, Sara L.; Nwachuku, Chuke; Goldman, Lee

doi:10.1007/s11606-008-0515-2

Cited by 31 publications

(22 citation statements)

References 23 publications

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“…The objective of this study was to determine effect of baseline QoL on stroke risk and outcomes in the ALLHAT study, demonstrating utility of simple VAS after previous work has demonstrated VAS and its transformation useful in cost-effectiveness studies in ALLHAT study population 31 .…”

Section: Discussionmentioning

confidence: 99%

Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Shams

Auchus

Oparil

et al. 2017

Stroke

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Background and Purpose The visual analogue scale (VAS) is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study and evaluate determinants of post-stroke change in QoL. In the ALLHAT study, among the 33,357 patients randomized to treatment arms, 1,525 suffered strokes; 1,202 (79%) strokes were non-fatal. This study cohort includes 32,318 (97%) subjects who completed the baseline VAS QoL estimate. Methods QoL was measured on a VAS and adjusted using a Torrance transformation (TQoL). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0–1) and by quartiles (≤0.81, >0.81 ≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first post-stroke TQoL using adjusted linear regression. Results After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% CI 0.89–0.98) per 0.1 unit increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (HR =1.20 [CI 1.00–1.44]) compared to the reference highest quartile TQoL. Post-stroke TQoL change was significant within all treatment groups (p≤.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of post-stroke TQoL with similar results for the untransformed QoL. Conclusions The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted post-stroke change in TQoL. Clinical Trials Registration https://clinicaltrials.gov/ct2/show/NCT00000542?term=allhat&rank=3 Unique Identifier: NCT00000542

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Section: Discussionmentioning

confidence: 99%

Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Shams

Auchus

Oparil

et al. 2017

Stroke

Self Cite

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“…Thiazide-type diuretics have also been shown to be less expensive. 207,208 In an extension of the ALLHAT study, chlorthalidone was found to be more cost-effective than amlodipine and lisinopril.…”

Section: Blood Pressure Screening and Treatmentmentioning

confidence: 99%

Value of Primordial and Primary Prevention for Cardiovascular Disease

Weintraub¹,

Daniels²,

Burke³

et al. 2011

Circulation

467

265

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Abstract-The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030 -make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society. (Circulation. 2011;124:967-990.)

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“…We did not analyze effective diet and lifestyle interventions for lowering blood pressure in patients with hypertension, 28,29 and we did not analyze the cost-effectiveness or other relative merits of specific antihypertensive medication classes or combinations. [30][31][32] Finally, we did not analyze the potential synergistic benefits of simultaneous implementation of the 2014 hypertension guidelines and guidelines for controlling high cholesterol, diabetes, obesity, and other risk factors for cardiovascular disease, nor did we assess the value of hypertension treatment as part of an integrated guideline for managing all risk factors for cardiovascular disease on the basis of calculated global risk. 24,25,33 In conclusion, our model results suggest that controlling hypertension in untreated patients according to the 2014 guidelines not only would prevent about 56,000 cardiovascular events and 13,000 deaths from cardiovascular causes annually but also would result in cost savings.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines

2015

N Engl J Med

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Cost-effectiveness of Chlorthalidone, Amlodipine, and Lisinopril as First-step Treatment for Patients with Hypertension: An Analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Cited by 31 publications

References 23 publications

Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial)

Value of Primordial and Primary Prevention for Cardiovascular Disease

Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines

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