Thiazide-based treatment better for obese; amlodipine therapy effective across all BMI groups
THURSDAY, Dec. 6 (HealthDay News) -- For patients with hypertension, the impact of the type of treatment on cardiovascular risk is affected by body size, according to a study published online Dec. 6 in The Lancet.
Michael A. Weber, M.D., from the State University of New York in Brooklyn, and colleagues examined whether the type of hypertension treatment impacts the cardiovascular outcomes of patients according to their body size using data from the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension trial. The primary end point was cardiovascular death, non-fatal myocardial infarction, or stroke.
The researchers found that, for patients allocated to benazepril and hydrochlorothiazide, the primary end point decreased with increasing body mass index (30.7 per 1,000 patient-years for normal-weight; 21.9 for overweight; and 18.2 for obese patients). For patients allocated to benazepril and amlodipine, the primary end point was similar for normal-weight, overweight, and obese participants (18.2, 16.9, and 16.5 per 1,000 patient-years, respectively). The rate of primary events was similar with benazepril and hydrochlorothiazide and benazepril and amlodipine in obese participants, while for overweight and normal-weight participants, the rates were significantly lower with benazepril and amlodipine (hazard ratios, 0.76 and 0.57, respectively).
"Hypertension in normal-weight and obese patients might be mediated by different mechanisms," the authors write. "Thiazide-based treatment gives less cardiovascular protection in normal-weight than obese patients, but amlodipine-based therapy is equally effective across body mass index subgroups and thus offers superior cardiovascular protection in non-obese hypertension."
Several authors disclosed financial ties to pharmaceutical companies, including Novartis, which funded the study.
Abstract (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61343-9/abstract )Full Text (subscription or payment may be required) (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61343-9/fulltext )Editorial (subscription or payment may be required) (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61819-4/fulltext )