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Case control
The use of diuretics plus calcium channel blockers for hypertension may be associated with a higher risk of myocardial infarction but not stroke compared with the combination of diuretics plus β blockers
  1. Rhonda M Cooper-DeHoff,
  2. Carl J Pepine
  1. Colleges of Pharmacy and Medicine, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Rhonda M Cooper-DeHoff
    Colleges of Pharmacy and Medicine, University of Florida, PO Box 100486, Gainesville, FL 32610-0486, USA; dehoff{at}

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Uncontrolled hypertension remains a problem

The primary reason for treating hypertension is to reduce the risk for cardiovascular (CV) adverse outcomes while achieving guideline recommended goal blood pressure (BP), which usually requires multiple medications from different antihypertensive classes. Yet epidemiologic data indicate that fewer than 50% of patients achieve guideline recommended goals so associated morbidity and mortality remains high. The relative contributions to lack of BP control and elevated outcome rate among inadequacies of a particular antihypertensive regimen (agent or class), physician inertia with dose titration or drug addition and patient non-adherence with a prescribed drug regimen and life style modifications, are unclear.

Observational study attempts to determine best antihypertensive drug combo

To address the first possibility, Boger-Megiddo and colleagues suggest there may be outcome differences based on antihypertensive regimen employed. The study utilised a case (n=353) control (n=952) design to assess outcomes in a low risk hypertensive population in a managed care setting. The investigators focused on antihypertensive regimens led by a diuretic (usually a thiazides diuretic) with either a β blocker, renin angiotensin system blocker or calcium antagonist …

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  • Funding CJP has received research grants Abbott Laboratories, the National Institutes of Health, Baxter, Pfizer, GlaxoSmithKline and Bioheart; is a consultant to Abbott Laboratories, Forest Labs, Novartis/Cleveland Clinic, NicOx, Angioblast, Sanofi-Aventis, Medtelligence and SLACK; and has received unrestricted educational grants from AstraZeneca, AtCor Medical, Daiichi Sankyo, Eli Lilly, Pfizer, Sanofi-Aventis and Schering-Plough.

  • Competing interests RCD has been received grant funding from Abbott Laboratories and the National Institutes of Health.