Diuretics plus calcium channel blockers were associated with a higher risk of myocardial infarction compared to diuretics plus beta blockers (OR 1.98; 95% CI 1.37-2.87).
Case-Control (n=1,305)
No
Does the use of diuretics plus calcium channel blockers or ACEi/ARBs compared to diuretics plus beta blockers affect the risk of myocardial infarction or stroke in patients with hypertension?
In hypertensive patients, a two-drug regimen of diuretics plus calcium channel blockers was associated with a higher risk of myocardial infarction compared to diuretics plus beta blockers.
Effect estimate: OR 1.98 (95% CI 1.37-2.87)
OBJECTIVE: To examine the association of myocardial infarction and stroke incidence with several commonly used two drug antihypertensive treatment regimens. Design Population based case-control study. Setting Group Health Cooperative, Seattle, WA, USA. PARTICIPANTS: Cases (n=353) were aged 30-79 years, had pharmacologically treated hypertension, and were diagnosed with a first fatal or non-fatal myocardial infarction or stroke between 1989 and 2005. Controls (n=952) were a random sample of Group Health members who had pharmacologically treated hypertension. We excluded individuals with heart failure, evidence of coronary heart disease, diabetes, or chronic kidney disease. Exposures One of three common two drug combinations: diuretics plus beta blockers; diuretics plus calcium channel blockers; and diuretics plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers. MAIN OUTCOME MEASURES: Myocardial infarction or stroke. RESULTS: Compared with users of diuretics plus beta blockers, users of diuretics plus calcium channel blockers had an increased risk of myocardial infarction (adjusted odds ratio (OR) 1.98, 95% confidence interval 1.37 to 2.87) but not of stroke (OR 1.02, 95% CI 0.63 to 1.64). The risks of myocardial infarction and stroke in users of diuretics plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers were slightly but not significantly lower than in users of diuretics plus beta blockers (myocardial infarction: OR 0.76, 95% CI 0.52 to 1.11; stroke: OR 0.71, 95% CI 0.46 to 1.10). CONCLUSIONS: In patients with hypertension, diuretics plus calcium channel blockers were associated with a higher risk of myocardial infarction than other common two drug treatment regimens. A large trial of second line antihypertensive treatments in patients already on low dose diuretics is required to provide a solid basis for treatment recommendations.
Boger-Megiddo et al. (Mon,) conducted a case-control in Hypertension (n=1,305). Diuretics plus calcium channel blockers vs. Diuretics plus beta blockers was evaluated on Myocardial infarction (OR 1.98, 95% CI 1.37-2.87). Diuretics plus calcium channel blockers were associated with a higher risk of myocardial infarction compared to diuretics plus beta blockers (OR 1.98; 95% CI 1.37-2.87).
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