SUNCT syndrome in two patients with prolactinomas and bromocriptine-induced attacks

Abstract

<h3>Summary</h3> <h3>Background and objectives</h3> CKD is common among older patients. This article assesses long-term renal and cardiovascular outcomes in older high-risk hypertensive patients, stratified by baseline estimated GFR (eGFR), and long-term outcome efficacy of 5-year first-step treatment with amlodipine or lisinopril, each compared with chlorthalidone. <h3>Design, setting, participants, &amp; measurements</h3> This was a long-term post-trial follow-up of hypertensive participants (<i>n</i>=31,350), aged ≥55 years, randomized to receive chlorthalidone, amlodipine, or lisinopril for 4–8 years at 593 centers. Participants were stratified by baseline eGFR (ml/min per 1.73 m²) as follows: normal/increased (≥90; <i>n</i>=8027), mild reduction (60–89; <i>n</i>=17,778), and moderate/severe reduction (&lt;60; <i>n</i>=5545). Outcomes were cardiovascular mortality (primary outcome), total mortality, coronary heart disease, cardiovascular disease, stroke, heart failure, and ESRD. <h3>Results</h3> After an average 8.8-year follow-up, total mortality was significantly higher in participants with moderate/severe eGFR reduction compared with those with normal and mildly reduced eGFR (<i>P</i>&lt;0.001). In participants with an eGFR &lt;60, there was no significant difference in cardiovascular mortality between chlorthalidone and amlodipine (<i>P</i>=0.64), or chlorthalidone and lisinopril (<i>P</i>=0.56). Likewise, no significant differences were observed for total mortality, coronary heart disease, cardiovascular disease, stroke, or ESRD. <h3>Conclusions</h3> CKD is associated with significantly higher long-term risk of cardiovascular events and mortality in older hypertensive patients. By eGFR stratum, 5-year treatment with amlodipine or lisinopril was not superior to chlorthalidone in preventing cardiovascular events, mortality, or ESRD during 9-year follow-up. Because data on proteinuria were not available, these findings may not be extrapolated to proteinuric CKD.