3032Cardiovascular outcomes for diuretic-based and non-diuretic-based regiments in high-risk hypertensive patients

Abstract

Objective: Whether thiazide diuretic‐based treatment is superior to non‐thiazide diuretic‐based treatment in preventing cardiovascular outcomes is still debated. The present study was to evaluate the treatment efficacy with the combination of dihydropyridine calcium‐channel blocker with diuretics or angiotensin II receptor blocker on reducing cardiovascular events. Methods: In a randomized, open‐label, blinded‐endpoint trial, hypertensive patients at high risk for cardiovascular events from 180 clinical centers in China were assigned to receive treatment with amlodipine plus amiloride/hydrochlorothiazide or telmisartan. The primary outcome was the composite of nonfatal stroke, nonfatal myocardial infarction or death from cardiovascular causes. Results: A total of 13542 patients received the combination regimens (6776 in amlodipine‐diuretics group; 6766 in amlodipine‐telmisartan group). The median follow‐up was 41 months. At the end of the trial, mean blood pressures were 131.1/78.4mm Hg in the diuretic‐based group and 131.0/78.3mm Hg in the telmisartan‐based group. No between‐group difference was observed in blood pressure lowering. However, the primary‐outcome events occurred in 181 patients (2.7%) in diuretic‐based group and in 229 (3.4%) in telmisartan‐based group, representing a relative risk reduction of 21% (hazard ratio, 0.79, 95% confidence interval [CI], 0.65 to 0.96; p=0.017). Of note, compared with non‐diuretic‐based regiments, diuretic‐based treatment decreased significantly cardiovascular death (hazard ratio, 0.64; p=0.033) and fatal and nonfatal stroke (hazard ratio, 0.79; p=0.041). Both treatments were safe and well tolerated. Conclusion: The diuretic‐based combination was more efficacious in preventing cardiovascular events than the non‐diuretic‐based combination in hypertensive patients with high risk for such events, independent of blood pressure reduction.