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Diuretics--a risk in the long-term treatment of hypertensive patients?
A Amery1, W Birkenhäger, C Bulpitt
1Inwendige Geneeskunde-Cardiologie, UZ Gasthuisberg, Leuven, Belgium.
Insights
Diuretic treatment, including hydrochlorothiazide and triamterene, significantly reduced cardiovascular mortality in elderly patients. Adding methyldopa did not yield significant benefits for cardiovascular events when analyzed separately.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- The European Working Party on High blood pressure in the Elderly (EWPHE) trial investigated hypertension management in older adults.
- Antihypertensive therapy in the elderly is crucial for reducing cardiovascular disease burden.
Purpose of the Study:
- To conduct a post hoc analysis of the EWPHE trial data.
- To evaluate the specific effects of diuretic treatment (hydrochlorothiazide and triamterene) on cardiovascular mortality and morbidity, both alone and in combination with methyldopa.
Main Methods:
- Utilized the Cox proportional hazard model for statistical analysis.
- Calculated relative hazard rates (RHR) to assess treatment efficacy.
- Performed intention-to-treat (ITT) analysis for cardiovascular mortality and morbidity outcomes.
Main Results:
- Diuretic treatment (hydrochlorothiazide and triamterene) showed a significant 34% reduction in cardiovascular mortality (RHR, 0.66; 95% CI, 0.44-0.97) in the ITT analysis.
- The combination of diuretics and methyldopa did not significantly reduce cardiovascular mortality (RHR, 0.84; 95% CI, 0.56-1.25).
- When all cardiovascular study-terminating events were considered, the combined diuretic and methyldopa group showed a significant 38% reduction (RHR, 0.62; 95% CI, 0.40-0.95).
Conclusions:
- Diuretic therapy with hydrochlorothiazide and triamterene is effective in lowering cardiovascular mortality in elderly hypertensive patients.
- The addition of methyldopa to diuretic therapy may offer benefits when considering a broader range of cardiovascular events.
- No significant impact of the studied treatments on all-cause mortality was observed.
Abstract:
The trial of the European Working Party on High blood pressure in the Elderly (EWPHE) revealed an overall decrease in cardiovascular mortality and morbidity in the actively treated patients. They received as first-line drugs a combination of hydrochlorothiazide and triamterene; methyldopa was added as necessary. The present post hoc analysis examined the effect of the diuretic treatment on cardiovascular events, both when given alone and in conjunction with methyldopa, by calculating the relative hazard rates (RHR) for cardiovascular mortality and morbidity. Using the Cox proportional hazard model, compared with placebo, a 34% reduction in cardiovascular mortality in the intention-to-treat analysis was demonstrated in the diuretic (hydrochlorothiazide and triamterene) group with an RHR of 0.66 and a 95% confidence interval (CI) of 0.44-0.97; the 16% decrease in the group treated with diuretics and methyldopa was not significant (RHR, 0.84; 95% CI, 0.56-1.25). The effect of treatment in the latter combined group became significant (RHR, 0.62; 95% CI, 0.40-0.95) when all cardiovascular study terminating events were considered; they were reduced by 38%. No effect of treatment on mortality from all causes was detected.