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Beta-blockers versus diuretics in hypertensive men: main results from the HAPPHY trial
L Wilhelmsen1, G Berglund, D Elmfeldt
1Department of Medicine, University of Göteborg, Ostra Hospital, Sweden.
Insights
Beta-blockers and thiazide diuretics showed similar effectiveness in preventing coronary heart disease (CHD) events and death in men with hypertension. Both treatments were well-tolerated, with no significant differences in overall mortality or diabetes incidence.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Choosing between beta-blockers and thiazide diuretics for hypertension management requires understanding their comparative efficacy and safety.
- Previous studies have yielded varied results regarding the optimal first-line antihypertensive therapy.
Purpose of the Study:
- To compare the effectiveness of beta-blocker-based treatment versus thiazide diuretic-based treatment in preventing coronary heart disease (CHD) events and death.
- To assess the safety and tolerability of these two antihypertensive drug classes in men with mild to moderate hypertension.
Main Methods:
- A randomized controlled trial involving men aged 40-64 years with mild to moderate hypertension (diastolic blood pressure 100-130 mmHg).
- Participants were assigned to either a diuretic or a beta-blocker treatment group, with additional medications added as needed to achieve normotension.
- Follow-up was conducted at 6-month intervals for a mean of 45.1 months, with standardized recording of blood pressure, side effects, and clinical endpoints.
Main Results:
- The incidence of CHD events did not differ significantly between the beta-blocker and diuretic groups.
- The incidence of fatal stroke was numerically lower in the beta-blocker group.
- Total mortality and overall adverse event rates were similar; however, patients on beta-blockers reported more symptoms, though withdrawal rates due to side effects were comparable.
Conclusions:
- Beta-blocker-based and thiazide diuretic-based antihypertensive treatments demonstrate comparable efficacy in preventing major cardiovascular complications, including CHD, in hypertensive men.
- Both treatment strategies are generally well-tolerated, with similar rates of patient withdrawal due to side effects.
- The choice between beta-blockers and thiazide diuretics may consider individual patient factors and symptom profiles.
Abstract:
Men aged 40-64 years with mild to moderate hypertension [diastolic blood pressure (DBP) 100-130 mmHg] were randomized to treatment with a diuretic (n = 3272) or a beta-blocker (n = 3297), with additional drugs if necessary, to determine whether a beta-blocker based treatment differs from thiazide diuretic based treatment with regard to the prevention of coronary heart disease (CHD) events and death. Patients with previous CHD, stroke or other serious diseases, or with contraindications to diuretics or beta-blockers were excluded. If normotension (DBP less than 95 mmHg) was not achieved by monotherapy, other antihypertensive drugs were added, but the two basic drugs were not crossed over. Patients were assessed at 6-monthly intervals. The mean follow-up for end-points was 45.1 months. Blood pressure (BP) side effects and end-points were recorded in a standardized manner. Entry characteristics and the BP reduction achieved were very similar in both treatment groups. All analyses were made on an intention-to-treat basis. The incidence of CHD did not differ between the two treatment groups. The incidence of fatal stroke tended to be lower in the beta-blocker treated group than in the diuretic treated group. Total mortality and the total number of end-points were similar in both groups. The percentage of patients withdrawn due to side effects was similar, whereas the number of reported symptoms, according to a questionnaire, was higher for patients on beta-blockers. The incidence of diabetes did not differ between the two groups. Subgroup analyses did not detect a difference in the effect of beta-blockers compared with diuretics in smokers as opposed to non-smokers, and beta-blockers also had the same effects as diuretics in the quartile with the highest predicted risk for CHD. Beta-blockers and thiazide diuretics were approximately equally well tolerated. The two drugs had a similar BP reducing effect although additional drugs had to be given more often in the diuretic group. Antihypertensive treatment based on a beta-blocker or on a thiazide diuretic could not be shown to affect the prevention of hypertensive complications, including CHD, to a different extent.