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Combination antihypertensive therapy among patients with COPD

Melissa A Herrin1, Laura Cecere Feemster2, Kristina Crothers3

  • 1Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA.

Chest
|January 5, 2013
PubMed

Insights

For patients with hypertension and COPD, combination therapy including a thiazide diuretic significantly reduced congestive heart failure hospitalizations. This benefit was observed in patients without a prior history of heart failure.

Area of Science:

  • Cardiology
  • Pulmonology
  • Pharmacology

Background:

  • Hypertension and COPD are independent risk factors for congestive heart failure (CHF).
  • Optimal antihypertensive therapy selection for patients with both COPD and hypertension remains unclear.
  • This study addresses the comparative effectiveness of dual antihypertensive therapies in this patient population.

Purpose of the Study:

  • To investigate the association between specific dual antihypertensive medication combinations and the risk of CHF hospitalization.
  • To compare the effectiveness of different antihypertensive regimens in patients with comorbid COPD and hypertension.

Main Methods:

  • A cohort of 7,104 patients with COPD and hypertension was identified from Veterans Administration hospitals (2001-2009).
  • Patients receiving two antihypertensive medications were analyzed using Cox proportional hazard models.
  • Follow-up extended through April 2009.

Main Results:

  • Combination therapies including a thiazide diuretic showed significantly lower risk of CHF hospitalization compared to beta-blockers plus ACEI/ARB.
  • Specifically, thiazide + beta-blocker (aHR=0.49), thiazide + ACEI/ARB (aHR=0.50), and thiazide + CCB (aHR=0.55) were associated with reduced CHF risk.
  • The observed association was primarily in patients without a prior CHF history and did not impact COPD exacerbation risk.

Conclusions:

  • For patients with hypertension and COPD on dual antihypertensive therapy, regimens including a thiazide diuretic are associated with a lower risk of CHF hospitalization.
  • This finding is particularly relevant for patients without a history of congestive heart failure.
  • The choice of antihypertensive combination therapy can influence CHF risk in this comorbid population.
Abstract

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