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Combination antihypertensive therapy among patients with COPD.
MedLine Citation:
PMID:  23287970     Owner:  NLM     Status:  Publisher    
BACKGROUND: Chronic obstructive pulmonary disease (COPD) and hypertension both increase the risk of congestive heart failure (CHF). Current clinical trials do not inform selection of combination antihypertensive therapy among patients with COPD. We performed a comparative effectiveness study to investigate whether choice of dual agent antihypertensive therapy is associated with risk of hospitalization for CHF among patients with these two conditions. METHODS: We identified a cohort of 7,104 patients with a diagnosis of COPD and hypertension receiving care within VA between 1/2001-12/2006 with follow-up through 4/2009. We included only patients prescribed two antihypertensive medications. We used Cox proportional hazard models for statistical analysis. RESULTS: Compared with beta-blockers plus an ACE-I/ARB, patients prescribed a thiazide diuretic plus a beta-blocker (adjusted hazard ratio [HR] = 0.49; 95% CI: 0.32 - 0.75), a thiazide plus an ACEI/ARB (adjusted HR = 0.50; 95% CI: 0.35 - 0.71), and a thiazide plus a CCB (adjusted HR = 0.55; 95% CI: 0.35 - 0.88) had a significantly lower risk of hospitalization for CHF. After stratification by previous history of CHF, we found this association was isolated only to those patients without a pre-existing history of CHF. Adjustment for patient characteristics and comorbidities had a small effect on risk of hospitalization. Antihypertensive medication combination choice had no significant association with risk of COPD exacerbation. CONCLUSIONS: Among patients with comorbid hypertension and COPD requiring two antihypertensive agents, combination therapy including a thiazide diuretic was associated with a significantly lower risk of hospitalization for CHF among patients without prior diagnosis of CHF.
Melissa A Herrin; Laura Cecere Feemster; Kristina A Crothers; Jane E Uman; Chris L Bryson; David H Au
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-3
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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