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, with a peer-reviewed article published in the Journal of Clinical Hypertension (J Clin Hypertens. 2015;17(11):848-54). 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.
An abstract with the main results of this analysis was presented at the Canadian Association for Population Therapeutics (CAPT) conference in Toronto (October 17-18, 2016).
A manuscript detailing the results of additional analysis using Marketscan database was recently published in the Journal of Clinical Hypertension:
Machado MAA, 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 Oct;19(10):999-1009.