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Machado MADÁ, de Moura CS, Wang Y, Danieli C, Abrahamowicz M, Bernatsky S, Behlouli H, Pilote L. Comparative effectiveness of antihypertensive drugs in nondiabetic patients with hypertension: A population-based study. J Clin Hypertens (Greenwich) 2017; 19:999-1009. [PMID: 28755451 DOI: 10.1111/jch.13055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/27/2017] [Accepted: 05/19/2017] [Indexed: 11/29/2022]
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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Affiliation(s)
| | - Cristiano Soares de Moura
- Division of Clinical Epidemiology, McGill University, Health Center Research Institute, Montreal, Quebec, Canada
| | - Yishu Wang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Coraline Danieli
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Division of Clinical Epidemiology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University and McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University and McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, McGill University, Health Center Research Institute, Montreal, Quebec, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Center Research Institute, Montreal, Quebec, Canada
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Zhu D, Yang K, Sun N, Gao P, Wang R, Grosso A, Zhang Y. Amlodipine/valsartan 5/160 mg versus valsartan 160 mg in Chinese hypertensives. Int J Cardiol 2012; 167:2024-30. [PMID: 22647413 DOI: 10.1016/j.ijcard.2012.05.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 02/23/2012] [Accepted: 05/06/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND A majority of hypertensives require treatment with ≥2 antihypertensive therapies to achieve blood pressure (BP) goals. Single-pill combinations (SPC) may improve convenience and adherence to therapy and reduce health care resource use and costs. The antihypertensive effects of amlodipine and valsartan are well established. This study evaluated the efficacy and safety of amlodipine/valsartan 5/160 mg SPC for the treatment of hypertension in predominantly Chinese patients not adequately controlled on valsartan 160 mg alone. METHODS In this multicentre study (24 centres), adults with stage 1 or 2 hypertension not adequately controlled with valsartan monotherapy were randomised to receive double-blind amlodipine/valsartan 5/160 mg SPC or valsartan 160 mg once daily for 8 weeks. RESULTS The least-square mean change (standard error) from baseline to endpoint in mean sitting diastolic blood pressure (MSDBP) at trough, the primary efficacy variable, was -10.3 (0.39) mm Hg with amlodipine/valsartan and -6.6 (0.40) mm Hg with valsartan (difference: -3.7 [0.54] mm Hg, p<0.0001). The corresponding results for mean sitting systolic blood pressure (MSSBP) were -14.9 (0.61) mm Hg and -7.0 (0.61) mm Hg, respectively (difference: -7.9 [0.84] mm Hg, p<0.0001). A significantly greater proportion of patients achieved overall BP control (MSSBP/MSDBP<140/90 mm Hg) with combination therapy (61.3%) versus monotherapy (39.3%; p<0.0001). Both treatments were well tolerated. CONCLUSION Amlodipine/valsartan 5/160 mg SPC is a safe and effective therapy for lowering BP in predominantly Chinese adults with stage 1 or 2 hypertension not adequately controlled with valsartan 160 mg monotherapy.
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Affiliation(s)
- Dingliang Zhu
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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