Cardiovascular outcomes of β-blocker-calcium channel blocker initial dual therapy vs. other initial dual therapies in Chinese patients with hypertension: A real-world retrospective study

Abstract

This retrospective study compared cardiovascular (CV) outcomes between initial β-blocker (BB) + calcium channel blocker (CCB) dual therapy ("B + C") and other initial dual therapies in Chinese newly diagnosed hypertensive patients. In this study, all patients in a regional electronic database with newly diagnosed hypertension from January 01, 2012 to December 31, 2016 who received any initial optimal dual therapy recommended by the Chinese hypertension guideline were included. 1:2 propensity score matching (PSM) was used to balance baseline characteristics between patients receiving B + C and patients receiving other initial dual therapies ("Others"). The primary outcome was major adverse cardiovascular events (MACE) that occurred from January 01, 2012 to December 31, 2017, consisting of non-fatal stroke, non-fatal myocardial infarction (MI), non-fatal chronic heart failure (CHF), and all-cause death. Cox proportional hazard models were used to compare these CV outcomes in the 2 matched cohorts. After the PSM, 6227 patients receiving B + C and 12 454 patients receiving Others were included. Compared to patients receiving Others, patients receiving B + C had a significantly lower risk of MACE (hazard ratio [HR] 0.85; 95% confidential interval [CI] 0.78-0.92; p < .001), non-fatal stroke (HR 0.89; 95% CI 0.81-0.98; p = .018) and non-fatal CHF (HR 0.74; 95% CI 0.63-0.86; p < .0001). Additionally, differences in risks of non-fatal MI and all-cause death between the 2 treatment cohorts were not statistically significant. In conclusion, BB + CCB initial dual therapy was associated with a lower risk of MACE, stroke, and CHF than other optimal initial dual therapies recommended by the Chinese hypertension guideline in Chinese newly diagnosed hypertensive patients.

Keywords: calcium channel blocker; hypertension; initial dual therapy; major adverse cardiovascular events; β-blocker.

FIGURE 1

Study flow chart (A), and Cohort exclusion/inclusion diagram (B). A, angiotensin II receptor blocker (ARB) or angiotensin‐converting enzyme inhibitor (ACEI); B, β‐blocker; C, calcium channel blocker; D, diuretics.

FIGURE 2

Kaplan–Meier curves for cumulative incidence (CI) of composite major adverse cardiovascular events (MACE) consisting of non‐fatal stroke, non‐fatal myocardial infarction (MI), non‐fatal chronic heart failure (CHF) and all‐cause death (A), non‐fatal stroke (B), non‐fatal CHF (C); non‐fatal MI (D), and all‐cause mortality (E). Blue represents initial B + C dual therapy (N = 6227), and red represents other initial dual therapies which included A + C, A + D, and C + D (N = 12 454). The analyses were conducted on patients receiving initial BB + CC dual therapy versus patients receiving other initial dual therapies after 1:2 propensity score matching (N = 18 681). A, angiotensin II receptor blocker (ARB) or angiotensin‐converting enzyme inhibitor (ACEI); B, beta blocker; C, calcium channel blocker; D, diuretics.

FIGURE 2

Kaplan–Meier curves for cumulative incidence (CI) of composite major adverse cardiovascular events (MACE) consisting of non‐fatal stroke, non‐fatal myocardial infarction (MI), non‐fatal chronic heart failure (CHF) and all‐cause death (A), non‐fatal stroke (B), non‐fatal CHF (C); non‐fatal MI (D), and all‐cause mortality (E). Blue represents initial B + C dual therapy (N = 6227), and red represents other initial dual therapies which included A + C, A + D, and C + D (N = 12 454). The analyses were conducted on patients receiving initial BB + CC dual therapy versus patients receiving other initial dual therapies after 1:2 propensity score matching (N = 18 681). A, angiotensin II receptor blocker (ARB) or angiotensin‐converting enzyme inhibitor (ACEI); B, beta blocker; C, calcium channel blocker; D, diuretics.

FIGURE 2

Kaplan–Meier curves for cumulative incidence (CI) of composite major adverse cardiovascular events (MACE) consisting of non‐fatal stroke, non‐fatal myocardial infarction (MI), non‐fatal chronic heart failure (CHF) and all‐cause death (A), non‐fatal stroke (B), non‐fatal CHF (C); non‐fatal MI (D), and all‐cause mortality (E). Blue represents initial B + C dual therapy (N = 6227), and red represents other initial dual therapies which included A + C, A + D, and C + D (N = 12 454). The analyses were conducted on patients receiving initial BB + CC dual therapy versus patients receiving other initial dual therapies after 1:2 propensity score matching (N = 18 681). A, angiotensin II receptor blocker (ARB) or angiotensin‐converting enzyme inhibitor (ACEI); B, beta blocker; C, calcium channel blocker; D, diuretics.

FIGURE 3

Kaplan–Meier curves for cumulative incidence (CI) of composite major adverse cardiovascular events (MACE) consisting of non‐fatal stroke, non‐fatal myocardial infarction (MI), non‐fatal chronic heart failure (CHF), and all‐cause death for patients receiving initial B + C dual therapy (blue) (N = 6227), A + C (red) (N = 9904), A + D (green) (N = 2038), and C + D (N = 512). A, angiotensin II receptor blocker (ARB) or angiotensin‐converting enzyme inhibitor (ACEI); B, beta blocker; C, calcium channel blocker; D, diuretics.