Comparison of the Effect of Thiazide Diuretics and Other Antihypertensive Drugs on Central Blood Pressure: Cross‐Sectional Analysis Among Nondiabetic Patients

Thiazide diuretics (TDs) are a cost‐effective first‐line therapy for uncomplicated hypertension; however, they are less prescribed than other options. The authors aimed to assess the noninferiority of TDs relative to different classes of antihypertensive medications in relation to central blood pressure. Cross‐sectional data from the Quebec CARTaGENE project was used. Nondiabetic hypertensive participants on monotherapy for hypertension were studied. Separate adjusted models were constructed to establish noninferiority of TDs to non‐TD antihypertensive medications for central blood pressure measurements. Models included a set of potential confounders. Of the 1194 hypertensive participants, 7.4% were taking TDs. We found that TDs were comparable with non‐TD antihypertensive medications for central systolic blood pressure (adjusted regression coefficient, 0.45; 95% confidence interval, −1.61 to 2.50). No differences in other central measurements were noted. The results provide additional support that TDs are at least as effective as other first‐line medications for treating uncomplicated hypertension.

Elevated blood pressure (BP) is a well‐known predictor of cardiovascular risk and mortality and lowering BP is an effective means of reducing cardiovascular events.¹, ² Although lifestyle modification is important in the management of hypertension, most hypertensive patients require some level of pharmacologic treatment.³ The use of antihypertensive medication has remarkably increased in the past years. A large‐scale national survey documented that 77% of US adults with hypertension used at least one antihypertensive medication.⁴ In Canada, the implementation of the Canadian Hypertension Education Program (CHEP), which is responsible for the generation of the hypertension guidelines in Canada and their annual update, has resulted in improved diagnosis and management of hypertension in Canada.⁵, ⁶ In adults with hypertension without compelling indications for specific agents, existing guidelines emphasize that thiazide diuretics (TDs), when used as monotherapy, are as effective as calcium channel blockers (CCBs), angiotensin‐converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs), in lowering BP and preventing cardiovascular and renal endpoints.², ⁷ Some studies have shown measurements of central systolic BP (cSBP) and central pulse pressure (cPP) to be better predictors of target organ damage and cardiovascular disease than peripheral (brachial) systolic BP (pSBP) or peripheral pulse pressure (pPP).⁸, ⁹ When compared with peripheral BP (pBP), central BP (cBP) offers a more accurate estimation of the load imposed on the aorta and the left ventricle, and, in turn, of the overall vascular damage and prognosis.¹⁰, ¹¹ cBP can be measured noninvasively using pulse wave analysis (PWA), a technique based on applanation tonometry of the radial artery. PWA provides additional information, in particular the calculation of the augmentation index (AIx).¹² AIx represents wave reflection, and an indirect measure of arterial stiffness.In this study, we aimed to assess the noninferiority of TDs relative to different classes of antihypertensive medications in relation to cBP and AIx.