title: Combination antihypertensive therapy among patients with COPD.
abstract: BACKGROUND
  COPD and hypertension both increase the risk of congestive heart failure (CHF). Current clinical trials do not inform the 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 COPD and hypertension receiving care within Veterans Administration hospitals between January 2001 and December 2006, with follow-up through April 2009. We included only patients prescribed two antihypertensive medications. We used Cox proportional hazard models for statistical analysis.
  
  
  RESULTS
  Compared with β-blockers plus an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, patients prescribed a thiazide diuretic plus a β-blocker (adjusted hazard ratio [HR], 0.49; 95% CI, 0.32-0.75), a thiazide plus an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (adjusted HR, 0.50; 95% CI, 0.35-0.71), and a thiazide plus a calcium channel blocker (adjusted HR, 0.55; 95% CI, 0.35-0.88) had a significantly lower risk of hospitalization for CHF. After stratification by history of CHF, we found that this association was isolated to patients without a history of CHF. Adjustment for patient characteristics and comorbidities had a small effect on risk of hospitalization. Choice of antihypertensive medication combination had no significant association with risk of COPD exacerbation.
  
  
  CONCLUSIONS
  Among patients with comorbid hypertension and COPD requiring two antihypertensive agents, combination therapy that includes a thiazide diuretic was associated with a significantly lower risk of hospitalization for CHF among patients without a history of CHF.
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA. Electronic address: herrinmelissa@gmail.com.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Herrin
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Division of Pulmonary and Critical Care Medicine, Seattle, WA.
authors.forename: Laura Cecere
authors.initials: LC
authors.lastname: Feemster
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Seattle, WA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Uman
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Division of Pulmonary and Critical Care Medicine, Seattle, WA.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D049993:Sodium Chloride Symporter Inhibitors