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Thiazide ‘best antihypertensive in obese patients’

A thiazide diuretic is a much better choice of antihypertensive for obese patients than it is for those who are lean, according to a new study.

A sub analysis of the ACCOMPLISH trial – of outcomes in 11,482 patients treated with the ACE inhibitor benazepril combined with hydrochlorothiazide or amlodipine - has found that rates of cardiovascular events differed significantly between groups of patients categorised by BMI depending on which combination they took.

In the diuretic arm the cardiovascular events per 1,000 patient-years was 18.2 in obese patients, rising to 21.9 in those who were overweight and 30.7 in those of normal weight.

But there was no significant difference between patient groups on benazepril and amlodipine, with 16.5, 16.9 and 18.2 per 1,000 patient years for obese, overweight andnormal weight patients respectively.

The authors concluded that ‘diuretic-based regimens seem to be a reasonable choice in obese patients in whom excess volume provides a rationale for this type of treatment, but thiazides are clearly less protective against cardiovascular events in patients who are lean.’

Lancet 2012, available online 6 December

Readers' comments (3)

  • Very interesting finding

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  • Is it just me or are these stats actually saying the converse i.e. that the benazepril + amlodipine increases CV events in those who are not obese, rather than the headline that the thiazide combination is protective?

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  • Ignore my comment above - I meant that the amlodipine combination effect is independent of BMI but thiazide combination increases risk of CV events in normal BMI patients, (rather than have an extra benefit in obese patients)

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