In a randomized , double-blind , practice-based Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial , 33,357 hypertensive participants , aged at least 55 years , were followed for an average of 4.9 years , for a primary outcome of fatal coronary heart disease or nonfatal myocardial infarction , and secondary outcomes of stroke , heart failure , combined cardiovascular disease , mortality , and renal failure .