TY - JOUR
T1 - Long-term comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events
T2 - A population-based retrospective inception cohort study in the Netherlands
AU - Li, Xuechun
AU - Bijlsma, Maarten J
AU - Bos, Jens H J
AU - Schuiling-Veninga, Catharina C M
AU - Hak, Eelko
N1 - © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/8/9
Y1 - 2023/8/9
N2 - OBJECTIVE: To determine the long-term effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events.DESIGN: Retrospective inception cohort study covering a 25-year study period.SETTING: University Groningen IADB.nl pharmacy prescription database with data from 1996 to 2020.PARTICIPANTS: Patients aged 18 years or older, free of any cardiovascular disease (CVD) drug therapies prior to initiation of a preventive antihypertensive monotherapy (ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs) and thiazides).OUTCOME MEASURES: Primary outcome was the time to first prescription of acute cardiac drug therapy (CDT) measured by valid drug proxies to identify a first major CVD event in patients without a history of CVD.RESULTS: Among 33 427 initiators, 5205 (15.6%) patients experienced an acute CDT. The average follow-up time was 7.9±5.5 years. The 25-year incidence rate per 1000 person-years were 25.3, 22.4, 18.2, 24.4 and 22.0 for ACEI, ARB, BB, CCB and thiazide starters, respectively. Inverse probability of treatment-weighted Cox regression showed that thiazide starters had lower hazards than the reference BB starters (HR: 0.88, 95% CI: 0.81 to 0.95). Among patients on diabetes drugs, risks were lower (HR: 0.49, 95% CI: 0.28 to 0.85). CCB starters had higher hazards than reference BB (HR: 1.21, 95% CI: 1.07 to 1.36). The overall estimated number needed to treat for thiazides compared with BBs to prevent one acute CDT in 25 years was 26, and four among patients on diabetes drugs.CONCLUSIONS: After adjustments for confounders, patients starting on monotherapy with thiazides had a lower incidence of CDT compared with those starting on BBs, notably among patients on diabetes drugs. Conversely, patients who began CCB monotherapy had a higher incidence of CDT compared with those starting on BBs. Other monotherapies had comparable incidence of cardiovascular disease compared with BBs.
AB - OBJECTIVE: To determine the long-term effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events.DESIGN: Retrospective inception cohort study covering a 25-year study period.SETTING: University Groningen IADB.nl pharmacy prescription database with data from 1996 to 2020.PARTICIPANTS: Patients aged 18 years or older, free of any cardiovascular disease (CVD) drug therapies prior to initiation of a preventive antihypertensive monotherapy (ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs) and thiazides).OUTCOME MEASURES: Primary outcome was the time to first prescription of acute cardiac drug therapy (CDT) measured by valid drug proxies to identify a first major CVD event in patients without a history of CVD.RESULTS: Among 33 427 initiators, 5205 (15.6%) patients experienced an acute CDT. The average follow-up time was 7.9±5.5 years. The 25-year incidence rate per 1000 person-years were 25.3, 22.4, 18.2, 24.4 and 22.0 for ACEI, ARB, BB, CCB and thiazide starters, respectively. Inverse probability of treatment-weighted Cox regression showed that thiazide starters had lower hazards than the reference BB starters (HR: 0.88, 95% CI: 0.81 to 0.95). Among patients on diabetes drugs, risks were lower (HR: 0.49, 95% CI: 0.28 to 0.85). CCB starters had higher hazards than reference BB (HR: 1.21, 95% CI: 1.07 to 1.36). The overall estimated number needed to treat for thiazides compared with BBs to prevent one acute CDT in 25 years was 26, and four among patients on diabetes drugs.CONCLUSIONS: After adjustments for confounders, patients starting on monotherapy with thiazides had a lower incidence of CDT compared with those starting on BBs, notably among patients on diabetes drugs. Conversely, patients who began CCB monotherapy had a higher incidence of CDT compared with those starting on BBs. Other monotherapies had comparable incidence of cardiovascular disease compared with BBs.
KW - Humans
KW - Antihypertensive Agents/therapeutic use
KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
KW - Angiotensin Receptor Antagonists/therapeutic use
KW - Retrospective Studies
KW - Cardiovascular Diseases/epidemiology
KW - Cohort Studies
KW - Netherlands/epidemiology
KW - Hypertension/drug therapy
KW - Calcium Channel Blockers/therapeutic use
KW - Adrenergic beta-Antagonists/therapeutic use
KW - Diuretics/therapeutic use
KW - Thiazides/therapeutic use
KW - Anti-Arrhythmia Agents/therapeutic use
KW - Primary Prevention
KW - Diabetes Mellitus/drug therapy
U2 - 10.1136/bmjopen-2022-068721
DO - 10.1136/bmjopen-2022-068721
M3 - Article
C2 - 37558444
SN - 2044-6055
VL - 13
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e068721
ER -