Comparison of First-Line Dual Combination Treatments in Hypertension: Real-World Evidence from Multinational Heterogeneous Cohorts
- Author:
Seng Chan YOU
1
;
Sungjae JUNG
;
Joel N SWERDEL
;
Patrick B RYAN
;
Martijn J SCHUEMIE
;
Marc A SUCHARD
;
Seongwon LEE
;
Jaehyeong CHO
;
George HRIPCSAK
;
Rae Woong PARK
;
Sungha PARK
Author Information
- Publication Type:Original Article
- Keywords: Hypertension; Antihypertensive agents; Angiotensin receptor antagonists; Calcium channel blockers; Diuretics
- MeSH: Adult; Angiotensin Receptor Antagonists; Antihypertensive Agents; Calcium Channel Blockers; Calcium Channels; Cardiovascular Diseases; Cohort Studies; Diuretics; Heart Failure; Humans; Hypertension; Korea; Mortality; Myocardial Infarction; Propensity Score; Stroke
- From:Korean Circulation Journal 2020;50(1):52-68
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: 2018 ESC/ESH Hypertension guideline recommends 2-drug combination as initial anti-hypertensive therapy. However, real-world evidence for effectiveness of recommended regimens remains limited. We aimed to compare the effectiveness of first-line anti-hypertensive treatment combining 2 out of the following classes: angiotensin-converting enzyme (ACE) inhibitors/angiotensin-receptor blocker (A), calcium channel blocker (C), and thiazide-type diuretics (D).METHODS: Treatment-naïve hypertensive adults without cardiovascular disease (CVD) who initiated dual anti-hypertensive medications were identified in 5 databases from US and Korea. The patients were matched for each comparison set by large-scale propensity score matching. Primary endpoint was all-cause mortality. Myocardial infarction, heart failure, stroke, and major adverse cardiac and cerebrovascular events as a composite outcome comprised the secondary measure.RESULTS: A total of 987,983 patients met the eligibility criteria. After matching, 222,686, 32,344, and 38,513 patients were allocated to A+C vs. A+D, C+D vs. A+C, and C+D vs. A+D comparison, respectively. There was no significant difference in the mortality during total of 1,806,077 person-years: A+C vs. A+D (hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.97−1.20; p=0.127), C+D vs. A+C (HR, 0.93; 95% CI, 0.87−1.01; p=0.067), and C+D vs. A+D (HR, 1.18; 95% CI, 0.95−1.47; p=0.104). A+C was associated with a slightly higher risk of heart failure (HR, 1.09; 95% CI, 1.01−1.18; p=0.040) and stroke (HR, 1.08; 95% CI, 1.01−1.17; p=0.040) than A+D.CONCLUSIONS: There was no significant difference in mortality among A+C, A+D, and C+D combination treatment in patients without previous CVD. This finding was consistent across multi-national heterogeneous cohorts in real-world practice.
