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Comparative effectiveness of antihypertensive drugs in nondiabetic patients with hypertension: A population-based
Marina Amaral de Ávila Machado1, Cristiano Soares de Moura1, Yishu Wang2
1Division of Clinical Epidemiology, McGill University, Health Center Research Institute, Montreal, Quebec, Canada.
Insights
Thiazide diuretics (TDs) are effective first-line treatments for hypertension. Patients on TDs had lower risks of drug changes and clinical events compared to other monotherapies.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Hypertension management involves selecting effective monotherapies.
- Comparing thiazide diuretics (TDs), ACE inhibitors (ACEIs), ARBs, and CCBs is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare the effectiveness of TD, ACEI, ARB, and CCB monotherapies in nondiabetic hypertension.
- To assess drug addition, discontinuation, and major cardiovascular/cerebrovascular events across different antihypertensive drug classes.
Main Methods:
- Utilized MarketScan Databases from 2010-2014.
- Employed multivariable Cox regression models to analyze patient data.
- Included over 565,000 patients initiating monotherapy.
Main Results:
- Patients on TDs showed a lower risk of requiring additional antihypertensive medication or discontinuing treatment compared to ACEI, ARB, and CCB groups.
- TD monotherapy was associated with a reduced risk of major adverse cardiovascular and cerebrovascular events.
- ACEIs were the most common initial monotherapy (43.6%), followed by CCBs (23.6%), TDs (18.8%), and ARBs (14.0%).
Conclusions:
- Thiazide diuretics demonstrate a favorable profile for first-line monotherapy in hypertension management.
- The findings support the use of TDs as a primary treatment choice for controlling hypertension.
- TDs offer a balance of treatment adherence and reduced clinical event risk.
Abstract:
The authors compared the effectiveness of thiazide diuretic (TD), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), and calcium channel blocker (CCB) monotherapies for the treatment of nondiabetic hypertension using MarketScan Databases 2010-2014. Multivariable Cox regression models assessed whether the addition of a new antihypertensive drug, treatment discontinuation, or switch and major cardiovascular or cerebrovascular events varied across groups. A total of 565 009 patients started monotherapy with ACEIs (43.6%), CCBs (23.6%), TDs (18.8%), or ARBs (14.0%). Patients who took TDs had a higher risk for either drug addition or discontinuation than patients who took ACEIs (hazard ratio [HR], 0.69 [95% CI, 0.68-0.70] vs HR, 0.81 [95% CI, 0.80-0.81]), ARBs (HR, 0.67 [95% CI, 0.66-0.68] vs HR, 0.66 [95% CI, 0.65-0.67]), and CCBs (HR, 0.85 [95% CI, 0.84-0.87] vs HR, 0.94 [95% CI, 0.93-0.95]). Conversely, patients who took TDs experienced a lower risk of clinical events compared with patients who took ACEIs (HR, 1.24 [95% CI, 1.15-1.33]), ARBs (HR, 1.28 [95% CI, 1.18-1.39]), and CCBs (HR, 1.35 [95% CI, 1.25-1.46]). Our results provide a strong rationale for choosing TDs as first-line monotherapy for the control of hypertension.
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