Give thiazides only to obese hypertensives

10:42 am Health Care

Hypertensive patients, who have a normal weight or who are overweight but not obese, appear to be better off on a non-diuretic-based regimen as per ACCOMPLISH trial.

Among normal-weight patients, a combination of the ACE inhibitor benazepril and the calcium channel blocker amlodipine was significantly better at reducing cardiovascular events than a combination of benazepril and hydrochlorothiazide (HR 0.57, P=0.0037), according to Michael Weber, MD, of SUNY Downstate Medical Center in Brooklyn, N.Y.

The amlodipine-based regimen also was superior in overweight patients (HR 0.76, P=0.0369) but not in obese patients (P=0.3189), Weber reported at the American Society of Hypertension meeting in New York.

In non-obese patients, thiazides may stimulate certain adverse mechanisms — including increased activity in the sympathetic and renin angiotensin systems — that result in poorer cardiovascular outcomes compared with those seen in obese patients.

Previous trials — including SHEP, LIFE, and INVEST — have shown that among patients receiving treatment for hypertension, leaner patients have higher cardiovascular event rates compared with those with a higher body mass index. Most of the patients in those studies were receiving thiazide diuretics. [MedPage]

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