Diuretic or Beta-Blocker for Hypertensive Patients Already Receiving ACEI/ARB and Calcium Channel Blocker

Min Shan Tsai, Chao Hsiun Tang, Chia Ying Lin, Po Ya Chuang, Nai Chuan Chen, Chien Hua Huang, Wei Tien Chang, Tzung Dau Wang, Ping Hsun Yu, Wen Jone Chen

Research output: Contribution to journalArticle

Abstract

Background: In patients already receiving combination of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and calcium channel blocker (CCB), whether the choice of additional diuretic or beta-blocker affects the cardiovascular and cerebrovascular outcomes remains unclear. Methods: A total of 13,551 patients who were concurrently receiving three anti-hypertensive agents of different classes through outpatient clinics during 2004−2006 were identified from the National Health Insurance Research Database of Taiwan. Patients were further classified into two treatment groups according to the medication possession ratio of drug combinations; the A + B + C group as those who received concurrent therapy of ACEI/ARB, beta-blocker and CCB. The A + C + D group as patients who received ACEI/ARB, CCB, and diuretics. The event-free survival of stroke, acute myocardial infarction (AMI), mortality, and major adverse cardiovascular events (MACE) between the two treatment groups was investigated. Results: After propensity score matching, there were 5120 patients in each group. There were no differences in the incidence of cardiovascular events between the two groups. In patients with prior history of cerebrovascular accident (CVA), the A + C + D group had a significantly higher AMI-free survival (adjusted HR = 1.56; 95% CI 1.051−2.307; p < 0.05) as compared with the A + B + C group. Conclusion: Adding a diuretic may be better than adding a beta-blocker for treating hypertensive patients with prior CVA history who have already received ACEIs/ARBs and CCBs.

Original languageEnglish
Pages (from-to)535-543
Number of pages9
JournalCardiovascular Drugs and Therapy
Volume31
Issue number5-6
DOIs
Publication statusPublished - Dec 1 2017

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Angiotensin Receptor Antagonists
Calcium Channel Blockers
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Stroke
Myocardial Infarction
Propensity Score
National Health Programs
Drug Combinations
Ambulatory Care Facilities
Taiwan
Antihypertensive Agents
Disease-Free Survival
Therapeutics
Databases
Survival
Mortality
Incidence
Research

Keywords

  • Hypertension
  • Mortality
  • Myocardial infarction
  • Stroke
  • Taiwan National Health Insurance Research database

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Diuretic or Beta-Blocker for Hypertensive Patients Already Receiving ACEI/ARB and Calcium Channel Blocker. / Tsai, Min Shan; Tang, Chao Hsiun; Lin, Chia Ying; Chuang, Po Ya; Chen, Nai Chuan; Huang, Chien Hua; Chang, Wei Tien; Wang, Tzung Dau; Yu, Ping Hsun; Chen, Wen Jone.

In: Cardiovascular Drugs and Therapy, Vol. 31, No. 5-6, 01.12.2017, p. 535-543.

Research output: Contribution to journalArticle

Tsai, MS, Tang, CH, Lin, CY, Chuang, PY, Chen, NC, Huang, CH, Chang, WT, Wang, TD, Yu, PH & Chen, WJ 2017, 'Diuretic or Beta-Blocker for Hypertensive Patients Already Receiving ACEI/ARB and Calcium Channel Blocker', Cardiovascular Drugs and Therapy, vol. 31, no. 5-6, pp. 535-543. https://doi.org/10.1007/s10557-017-6765-7
Tsai, Min Shan ; Tang, Chao Hsiun ; Lin, Chia Ying ; Chuang, Po Ya ; Chen, Nai Chuan ; Huang, Chien Hua ; Chang, Wei Tien ; Wang, Tzung Dau ; Yu, Ping Hsun ; Chen, Wen Jone. / Diuretic or Beta-Blocker for Hypertensive Patients Already Receiving ACEI/ARB and Calcium Channel Blocker. In: Cardiovascular Drugs and Therapy. 2017 ; Vol. 31, No. 5-6. pp. 535-543.
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AU - Tsai, Min Shan

AU - Tang, Chao Hsiun

AU - Lin, Chia Ying

AU - Chuang, Po Ya

AU - Chen, Nai Chuan

AU - Huang, Chien Hua

AU - Chang, Wei Tien

AU - Wang, Tzung Dau

AU - Yu, Ping Hsun

AU - Chen, Wen Jone

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N2 - Background: In patients already receiving combination of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and calcium channel blocker (CCB), whether the choice of additional diuretic or beta-blocker affects the cardiovascular and cerebrovascular outcomes remains unclear. Methods: A total of 13,551 patients who were concurrently receiving three anti-hypertensive agents of different classes through outpatient clinics during 2004−2006 were identified from the National Health Insurance Research Database of Taiwan. Patients were further classified into two treatment groups according to the medication possession ratio of drug combinations; the A + B + C group as those who received concurrent therapy of ACEI/ARB, beta-blocker and CCB. The A + C + D group as patients who received ACEI/ARB, CCB, and diuretics. The event-free survival of stroke, acute myocardial infarction (AMI), mortality, and major adverse cardiovascular events (MACE) between the two treatment groups was investigated. Results: After propensity score matching, there were 5120 patients in each group. There were no differences in the incidence of cardiovascular events between the two groups. In patients with prior history of cerebrovascular accident (CVA), the A + C + D group had a significantly higher AMI-free survival (adjusted HR = 1.56; 95% CI 1.051−2.307; p < 0.05) as compared with the A + B + C group. Conclusion: Adding a diuretic may be better than adding a beta-blocker for treating hypertensive patients with prior CVA history who have already received ACEIs/ARBs and CCBs.

AB - Background: In patients already receiving combination of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) and calcium channel blocker (CCB), whether the choice of additional diuretic or beta-blocker affects the cardiovascular and cerebrovascular outcomes remains unclear. Methods: A total of 13,551 patients who were concurrently receiving three anti-hypertensive agents of different classes through outpatient clinics during 2004−2006 were identified from the National Health Insurance Research Database of Taiwan. Patients were further classified into two treatment groups according to the medication possession ratio of drug combinations; the A + B + C group as those who received concurrent therapy of ACEI/ARB, beta-blocker and CCB. The A + C + D group as patients who received ACEI/ARB, CCB, and diuretics. The event-free survival of stroke, acute myocardial infarction (AMI), mortality, and major adverse cardiovascular events (MACE) between the two treatment groups was investigated. Results: After propensity score matching, there were 5120 patients in each group. There were no differences in the incidence of cardiovascular events between the two groups. In patients with prior history of cerebrovascular accident (CVA), the A + C + D group had a significantly higher AMI-free survival (adjusted HR = 1.56; 95% CI 1.051−2.307; p < 0.05) as compared with the A + B + C group. Conclusion: Adding a diuretic may be better than adding a beta-blocker for treating hypertensive patients with prior CVA history who have already received ACEIs/ARBs and CCBs.

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