Incidence and predictors of angioedema in elderly hypertensive patients at high risk for cardiovascular disease: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

J Clin Hypertens (Greenwich). 2006 Sep;8(9):649-56; quiz 657-8. doi: 10.1111/j.1524-6175.2006.05689.x.


Angioedema is a rare, potentially life-threatening condition that has been associated with angiotensin-converting enzyme inhibitors since their introduction in the 1980s. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest antihypertensive study conducted to date, randomized 42,418 participants to a diuretic (chlorthalidone), a calcium channel blocker (amlodipine), an angiotensin-converting enzyme inhibitor (lisinopril), or an alpha-blocker (doxazosin). Patients who developed angioedema were compared for baseline characteristics and changes in antihypertensive drug administration. Fifty-three participants developed angioedema during active follow-up: 55% were black, 60% men, and 70% were assigned to lisinopril (including 62% of black participants with angioedema), 15% to chlorthalidone, 9% to doxazosin, and 6% to amlodipine. Six percent occurred within a day of randomization and 23% within the first week. Over half did not have an increase in their assigned (blinded) antihypertensive drug before angioedema onset; 3 (6%) had a dose increase within a week before onset. One patient died following an angioedema episode. The occurrence of angioedema in the angiotensin-converting enzyme inhibitor arm corresponds with previously reported angioedema-angiotensin-converting enzyme inhibitor associations.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amlodipine / administration & dosage
  • Amlodipine / adverse effects*
  • Angioedema / chemically induced*
  • Angioedema / epidemiology
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / adverse effects*
  • Canada / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Chlorthalidone / administration & dosage
  • Chlorthalidone / adverse effects*
  • Female
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / physiopathology
  • Incidence
  • Lisinopril / administration & dosage
  • Lisinopril / adverse effects*
  • Male
  • Middle Aged
  • Prognosis
  • Risk Factors
  • Time Factors
  • United States / epidemiology


  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Amlodipine
  • Lisinopril
  • Chlorthalidone