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Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):453-8. doi: 10.1161/CIRCOUTCOMES.110.940874. Epub 2010 Aug 17.

Comparative effectiveness of angiotensin-converting enzyme inhibitors versus beta-blockers as second-line therapy for hypertension.

Author information

1
Institute for Health Research, Kaiser Permanente Colorado, University of Colorado, 10065 E Harvard Ave., Denver, CO 80231, USA. David.J.Magid@kp.org

Abstract

BACKGROUND:

Trials comparing hypertension monotherapies have found either no difference or modest differences in blood pressure (BP) and cardiovascular events. However, no trial has assessed the comparative effectiveness of 2nd-line therapy in patients whose BP was not controlled with a thiazide diuretic.

METHODS AND RESULTS:

This was an observational study conducted with a hypertension registry of adults enrolled in 3 large integrated health care delivery systems from 2002 to 2007. Patients newly started on thiazide monotherapy whose BP remained uncontrolled were observed after addition of either an angiotensin-converting enzyme (ACE) inhibitor or β-blocker for subsequent BP control and cardiovascular events. Patients for whom either add-on drug was indicated or contraindicated were excluded. After adjustment for patient characteristics and study year, BP control during the subsequent 6 to 18 months was comparable for the 2 agents (70.5% ACE, 69.0% β-blockers; P=0.09). Rates of incident myocardial infarction (hazard ratio, 1.05; 95% confidence interval, 0.69 to 1.58) and stroke (hazard ratio, 1.01; 95% confidence interval, 0.68 to 1.52) were also similar for the ACE inhibitor and β-blocker groups during an average of 2.3 years of follow-up. There were also no differences in heart failure or renal function.

CONCLUSIONS:

ACE inhibitors and β-blockers are equally effective in lowering BP and preventing cardiovascular events for patients whose BP is not controlled with a thiazide diuretic alone and who have no compelling indication for a specific 2nd-line agent.

PMID:
20716714
PMCID:
PMC3517880
DOI:
10.1161/CIRCOUTCOMES.110.940874
[Indexed for MEDLINE]
Free PMC Article
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