Machado Marina Amaral de Ávila, de Moura Cristiano Soares, Wang Yishu, Danieli Coraline, Abrahamowicz Michal, Bernatsky Sasha, Behlouli Hassan, Pilote Louise
Division of Clinical Epidemiology, McGill University, Health Center Research Institute, Montreal, Quebec, Canada.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
J Clin Hypertens (Greenwich). 2017 Oct;19(10):999-1009. doi: 10.1111/jch.13055. Epub 2017 Jul 29.
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.
作者利用2010 - 2014年市场扫描数据库，比较了噻嗪类利尿剂（TD）、血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体阻滞剂（ARB）和钙通道阻滞剂（CCB）单药治疗非糖尿病性高血压的疗效。多变量Cox回归模型评估了添加新的抗高血压药物、治疗中断或换药以及主要心血管或脑血管事件在不同组间是否存在差异。共有565009例患者开始使用ACEI（43.6%）、CCB（23.6%）、TD（18.8%）或ARB（14.0%）进行单药治疗。与服用ACEI的患者相比，服用TD的患者增加药物或停药的风险更高（风险比[HR]，0.69[95%CI，0.68 - 0.70]对HR，0.81[95%CI，0.80 - 0.81]），与服用ARB的患者相比（HR，0.67[95%CI，0.66 - 0.68]对HR，0.66[95%CI，0.65 - 0.67]），与服用CCB的患者相比（HR，0.85[95%CI，0.84 - 0.87]对HR，0.94[95%CI，0.93 - 0.95]）。相反，与服用ACEI的患者相比（HR，1.24[95%CI，1.15 - 1.33]），服用TD的患者发生临床事件的风险较低，与服用ARB的患者相比（HR，1.28[95%CI，1.18 - 1.39]），与服用CCB的患者相比（HR，1.35[95%CI，1.25 - 1.46]）。我们的结果为选择TD作为控制高血压的一线单药治疗提供了有力依据。
