Most estimates show no differences in effectiveness between classes of antihypertensive agents, according to a systematic, multinational, large-scale analysis published online last week in The Lancet.

Marc A. Suchard, M.D., from the University of California in Los Angeles, and colleagues conducted a systematic, multinational, large-scale study to estimate the relative risks of three primary (acute myocardial infarction, hospitalization for heart failure, and stroke) and six secondary effectiveness outcomes as well as 46 safety outcomes associated with use of different monotherapy drug classes for hypertension using real-world evidence.

Twenty-two thousand calibrated, propensity score-adjusted hazard ratios were generated comparing all classes and outcomes across databases for 4.9 million patients.

The researchers found no effectiveness differences between classes in most estimates; however, better primary effectiveness was seen for thiazide or thiazide-like diuretics than angiotensin-converting enzyme inhibitors (hazard ratios, 0.84, 0.83, and 0.83 for acute myocardial infarction, hospitalization for heart failure, and stroke, respectively, while on initial treatment).

Thiazide or thiazide-like diuretics were favoured over angiotensin-converting enzyme inhibitors in safety profiles. Compared with four other classes (thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and dihydropyridine calcium channel blockers), non-dihydropyridine calcium channel blockers were significantly inferior.

“Going forward, use of this analytical technique in this scenario might allow new insights and clarify otherwise unanswerable questions to empower clinicians to practice evidence-based medicine,” wrote the authors of an accompanying editorial.


REFERENCE: Suchard et al: Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis;