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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
Summary
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.
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