[137] A subgroup analysis of this patient population found that the ACEI (lisinopril) was less effective in lowering blood pressure than the thiazide-type diuretic (chlorthalidone) or the long-acting dihydropyridine (LA DHP) CCB (amlodipine).[136] Although there was no significant difference between an ACEI or thiazide-type diuretic in the primary outcome of combined fatal CHD or nonfatal MI, the subgroup analysis of African American patients found that those participants randomized to the ACEI versus the thiazide-type diuretic were at a 40% greater risk of stroke, 30% greater risk of heart failure, 19% greater risk of CVD, and 15% greater risk of combined CHD.[136] There was no difference in major CVD outcomes between the thiazide-type diuretic and the LA DHP CCB in the subgroup of African American patients, other than a higher incidence of heart failure with the CCB.[136] The ALLHAT study also found that African American patients randomized to the LA DHP CCB (amlodipine) had greater adherence to treatment and required fewer medications to reach the blood pressure goal than those randomly assigned to the ACEI (lisinopril).[138] Additionally, the Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study reported that African Americans prescribed a beta-blocker (atenolol) had better cardiovascular outcomes than those prescribed an ARB (losartan).[139] In the African American Study of Kidney Disease and Hypertension (AASK), ACEIs were found to be more effective than beta-blockers or LA DHP CCBs in slowing glomerular filtration rate (GFR) decline among African American patients with proteinuria.[140] The AASK trial would suggest that African Americans with CKD should be placed on an ACEI, but the ALLHAT study reported that chlorthalidone was superior to lisinopril for CVD outcomes in African Americans.