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Original Research: COPD |

Combination Antihypertensive Therapy Among Patients With COPDDual Antihypertensive Therapy and COPD

Melissa A. Herrin, BA; Laura Cecere Feemster, MD; Kristina Crothers, MD; Jane E. Uman, MPH; Chris L. Bryson, MD; David H. Au, MD
Author and Funding Information

From the Health Services Research and Development (Mss Herrin and Uman and Drs Feemster, Bryson, and Au), VA Puget Sound Health Care System, Seattle, WA; and Division of Pulmonary and Critical Care Medicine (Drs Feemster, Crothers, and Au) and Division of General Internal Medicine (Dr Bryson), Department of Medicine, University of Washington School of Medicine, Seattle, WA.

Correspondence to: Melissa A. Herrin, BA, 1100 Olive Way, Ste 1400, Seattle, WA 98101; e-mail: herrinmelissa@gmail.com


Funding/support: This material is based on work supported by the Department of Veterans Affairs, Health Services Research and Development, and American Lung Association Grant CI-51755N. Dr Feemster is supported by a Veterans Affairs Health Services Research and Development fellowship (TPM 61-037).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1312-1320. doi:10.1378/chest.12-1770
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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.

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