Query 11-03: How do thiazide diuretics compare to ACE inhibitors and combination antihypertensive products in terms of effectiveness (and cost-effectiveness) for the management of hypertension in non-diabetic patients?
This project, which originated with a query by British Columbia Ministry of Health, was funded in 2013 for 3 years. Initial results have been generated and discussed with DSEN and Health Canada. Additional analysis have been conducted with Marketscan database (2011-2014). We constructed a retrospective cohort of non-diabetic hypertensive adults who were new users of thiazide diuretics (TD), converting enzyme inhibitor (ACEi), calcium-channel blockers (CCB), or angiotensin-2 antagonists (ARB) as monotherapy. We performed Cox regression models to assess the risk for drug discontinuation, adding a drug or switching to a new drug, and a composite outcome of clinical events including myocardial infarction, unstable angina, stroke, and heart failure. The TD group was more likely to discontinue therapy versus ACEI (HR=0.79 95%CI 0.74-0.84), ARB (HR=0.66 95%CI 0.61-0.72) and CCB (HR=0.86 95%CI 0.80-0.92). Similar trends were found for adding a drug or switching to a new drug. There was a higher risk for the clinical events in ACEi (HR=1.46 95%CI 1.08-1.96) or CCB (HR=1.54 95%CI 1.13-2.11) groups versus TD, while the comparison with ARB were inconclusive.
Moura et al. Comparison of the Effect of Thiazide Diuretics and Other Antihypertensive Drugs on Central Blood Pressure: Cross-Sectional Analysis Among Nondiabetic Patients; J Clin Hypertens. 2015;17:848–854