Thiazide diuretics as first-line treatment for hypertension: meta-analysis and economic evaluation
Tran K, Ho C, Noorani HZ, Cimon K, Hodgson A, Coyle D, Coyle K, Myers MG, Wright NLJM
Record ID 32008000102
"The aim of this health technology assessment is to evaluate the evidence for the clinical effects and the economic implications of thiazide diuretics when used as a first-line treatment for hypertension. This assesement is intended to inform those who must decide on an optimal choice of antihypertensive drug therapy in a patient diagnosed with hypertension for the first time. The economic implications of treating a typical newly diagnosed 55- or 65-year-old patient, with no significant additional risk factors such as heart disease, abnormal blood cholesterol, or diabetes are also examined. The effects of reducing blood pressure below the standard target of 140/90 mm Hg are also evaluated." (executive summary)
TZD-based therapy is superior to placebo or no treatment in reducing the risks of all-CV and CRV events in subjects with uncomplicated hypertension. No significant differences for all-CV and CVRrelated mobidity and mortality were found when TZD were compared with other antihypertensive medications. TZD, however, were better in reducing the risk of stroke than ACE inhibitors and in reducing the risk of HF than CCB.
The economic analysis found little difference between therapies in terms of effectiveness and found TZD to be the most cost-effective initial therapy fo patients in all study populations, unless society is willing to pay more than CAD400,000 for a QALY gained from the use of CCB.
Evidence from a limited number of trials, most of which were low quality, showed that the intensive lowering of blood pressure below the standard target of 140/190 mm Hg in patients with hypertension did not result in a difference in the risks of all-cause death, death related to cardiovascular events, and renal failure.
English language abstract:
An English language summary is available
- Antihypertensive Agents
- Sodium Chloride Symporter Inhibitors
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