Journal
KOREAN CIRCULATION JOURNAL
Volume 50, Issue 1, Pages 52-68Publisher
KOREAN SOC CARDIOLOGY
DOI: 10.4070/kcj.2019.0173
Keywords
Hypertension; Antihypertensive agents; Angiotensin receptor antagonists; Calcium channel blockers; Diuretics
Categories
Funding
- Korea Health Technology RAMP
- D Project through the Korea Health Industry Development Institute (KHIDI) - Ministry of Health AMP
- Welfare, Republic of Korea [HI16C0992]
- Korean Centers for Disease Control and Prevention [2018ER630200]
- Fire Fighting Safety AMP
- 119 Rescue Technology Research and Development Program - National Fire Agency [MPSS-FireSafety-2015-80]
- US National Science Foundation [IIS 1251151]
- Korea Health Promotion Institute [HR16C0001040019] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)
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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-naive 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 1(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% Cl, 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.
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