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. 2015 Nov;17(11):857-65.
doi: 10.1111/jch.12623. Epub 2015 Jul 24.

Ambulatory Blood Pressures in Hypertensive Patients Treated With One Antihypertensive Agent: Differences Among Drug Classes and Among Drugs Belonging to the Same Class

Alejandro de la Sierra  1 , Manuel Gorostidi  2 , José R Banegas  3 , Julián Segura  4 , Ernest Vinyoles  5 , Juan J de la Cruz  3 , Luis M Ruilope  4
Affiliations

Ambulatory Blood Pressures in Hypertensive Patients Treated With One Antihypertensive Agent: Differences Among Drug Classes and Among Drugs Belonging to the Same Class

Alejandro de la Sierra et al. J Clin Hypertens (Greenwich). 2015 Nov.

Abstract

The authors investigated the differences in office and ambulatory blood pressure (BP) among major antihypertensive drug classes and among frequently used drugs in each class in 22,617 patients treated with monotherapy from the Spanish ABPM Registry. Using thiazides as the reference group, patients treated with calcium channel blockers have significantly (P<.01) elevated ambulatory BP and less ambulatory control after adjusting for confounders. Inside each class, no significant differences were observed among thiazides or angiotensin receptor blockers. Atenolol and bisoprolol among β-blockers, amlodipine among calcium channel blockers, and lisinopril and enalapril among angiotensin-converting enzyme inhibitors exhibited lower ambulatory BP and better control than other agents. Differences exist among antihypertensive drug classes and among different compounds in each class with respect to ambulatory BP control. This can help physicians choose among drug classes and among compounds in each class if BP reduction is the main objective of treatment.

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Figures

Figure 1
Figure 1
Plots showing odds ratios (99% confidence intervals) of the association of each drug class with the probability of having blood pressure (BP) controlled. Thiazides were used as the reference group. Panel A: Office BP control (<140/90 mm Hg). Panel B: 24‐hour BP control (<130/80 mm Hg). Panel C: Daytime BP control (<135/85 mm Hg). Panel D: Nighttime BP control (<120/70 mm Hg). CCB indicates calcium channel blockers: ACE, angiotensin‐converting enzyme inhibitors; ARBs, angiotensin receptor blockers.
Figure 2
Figure 2
Plots showing odds ratios (99% confidence intervals) of the association of most used (more than 100 patients) thiazide‐like diuretics with the probability of having blood pressure (BP) controlled. Chlorthalidone was used as the reference group. Panels A, B, C, and D as in Figure 1. HCTZ indicates hydrochlorothiazide.
Figure 3
Figure 3
Plots showing odds ratios (99% confidence intervals) of the association of most used β‐blockers (more than 100 patients) with the probability of having blood pressure (BP) controlled. Atenolol used as the reference group. Panels A, B, C, and D, as in Figure 1. ATL indicates atenolol; BIS, bisoprolol; CRT, carteolol; CVD, carvedilol; NEV, nebivolol; PRP, propranolol.
Figure 4
Figure 4
Plots showing odds ratios (99% confidence intervals) of the association of most used calcium channel blockers (more than 100 patients) with the probability of having blood pressure (BP) controlled. Amlodipine was used as the reference group. Panels A, B, C, and D, as in Figure 1. AML indicates amlodipine; LER, lercanidipine; MAN, manidipine; NIF, nifedipine; DIL, diltiazem; VPM, verapamil.
Figure 5
Figure 5
Plots showing odds ratios (99% confidence intervals) of the association of most used angiotensin‐converting enzyme inhibitor (more than 100 patients) with the probability of having blood pressure (BP) controlled. Captopril was used as the reference group. Panels A, B, C, and D, as in Figure 1. CPT indicates captopril; ENL, enalapril; LIS, lisinopril; QNP, quinapril; RAM, ramipril.
Figure 6
Figure 6
Plots showing odds ratios (99% confidence intervals) of the association of most used angiotensin receptor blockers (more than 100 patients) with the probability of having blood pressure (BP) controlled. Losartan was used as the reference group. Panels A, B, C, and D, as in Figure 1. LOS indicates losartan; VAL, valsartan; IRB, irbesartan; CAN, candesartan; TEL, telmisartan; EPR, eprosartan; OLM, olmesartan.
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References

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