Open AccessComparative effectiveness of antihypertensive drugs in nondiabetic patients with hypertension: A population‐based study
Author(s) -
Machado Marina Amaral de Ávila,
Moura Cristiano Soares,
Wang Yishu,
Danieli Coraline,
Abrahamowicz Michal,
Bernatsky Sasha,
Behlouli Hassan,
Pilote Louise
Publication year - 2017
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.13055
Subject(s) - medicine , discontinuation , hazard ratio , diuretic , proportional hazards model , antihypertensive drug , angiotensin receptor , calcium channel blocker , population , confidence interval , blood pressure , angiotensin ii , environmental health
The authors compared the effectiveness of thiazide diuretic ( TD ), angiotensin‐converting enzyme inhibitor ( ACE I), 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 ACE Is ( 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 TD s as first‐line monotherapy for the control of hypertension.