August 11, 2016

Hypertension in non-diabetic patients: thiazide diuretics and ACE inhibitors

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.

Machado et al. Comparative effectiveness of antihypertensive drugs in nondiabetic patients with hypertension: A population-based study. J Clin Hypertens (Greenwich). 2017 Oct;19(10):999-1009.

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

Moura et al. Hypertension treatment and cross-sectional relationship with peripheral and central blood pressure in non–diabetic participants from the CARTaGENE Cohort Study. 2014. (CAPT abstract)

Machado MAA et al. Comparative effectiveness of thiazide diuretics and other monotherapies for nondiabetic individuals with hypertension. 2016. (CAPT abstract)

For more information contact: Jessica (Lifang) Wang. Research Coordinator. [email protected]   514.934.1934 ext.44718