Diuretic or Beta-Blocker for Hypertensive Patients Already Receiving ACEI/ARB and Calcium Channel Blocker
Journal
Cardiovascular Drugs and Therapy
Journal Volume
31
Journal Issue
5-6
Pages
535-543
Date Issued
2017
Author(s)
Tang C.-H.
Lin C.-Y.
Chuang P.-Y.
Chen N.-C.
Yu P.-H.
Abstract
Background: In patients already receiving combination of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and calcium channel blocker (CCB), whether the choice of additional diuretic or beta-blocker affects the cardiovascular and cerebrovascular outcomes remains unclear. Methods: A total of 13,551 patients who were concurrently receiving three anti-hypertensive agents of different classes through outpatient clinics during 2004?2006 were identified from the National Health Insurance Research Database of Taiwan. Patients were further classified into two treatment groups according to the medication possession ratio of drug combinations; the A + B + C group as those who received concurrent therapy of ACEI/ARB, beta-blocker and CCB. The A + C + D group as patients who received ACEI/ARB, CCB, and diuretics. The event-free survival of stroke, acute myocardial infarction (AMI), mortality, and major adverse cardiovascular events (MACE) between the two treatment groups was investigated. Results: After propensity score matching, there were 5120 patients in each group. There were no differences in the incidence of cardiovascular events between the two groups. In patients with prior history of cerebrovascular accident (CVA), the A + C + D group had a significantly higher AMI-free survival (adjusted HR = 1.56; 95% CI 1.051?2.307; p < 0.05) as compared with the A + B + C group. Conclusion: Adding a diuretic may be better than adding a beta-blocker for treating hypertensive patients with prior CVA history who have already received ACEIs/ARBs and CCBs. ? 2017, Springer Science+Business Media, LLC, part of Springer Nature.
SDGs
Other Subjects
angiotensin receptor antagonist; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; diuretic agent; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; diuretic agent; acute heart infarction; adult; aged; antihypertensive therapy; Article; cardiovascular mortality; cardiovascular risk; cerebrovascular accident; cohort analysis; combination drug therapy; controlled study; drug efficacy; drug safety; event free survival; female; human; hypertension; incidence; major clinical study; male; mortality risk; national health insurance; outpatient department; priority journal; propensity score; retrospective study; risk reduction; Taiwan; cerebrovascular accident; combination drug therapy; disease free survival; heart infarction; hypertension; middle aged; mortality; Adrenergic beta-Antagonists; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cohort Studies; Disease-Free Survival; Diuretics; Drug Therapy, Combination; Female; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Propensity Score; Retrospective Studies; Stroke; Taiwan
Type
journal article