Does thiazide use result in a decreased risk of heart failure in patients taking intensive blood pressure treatment?

This study examined whether thiazide use had a benefitted patients receiving intensive blood pressure (BP) treatment for high blood pressure (HBP) in terms of heart disease risk. The authors found that these patients had a decreased risk of having an adverse cardiovascular event. 

Hypertension (HBP) is an important problem worldwide. Having HBP is regarded to increase the risks of developing heart disease, heart failure, and increases the occurrence of conditions such as heart attack or stroke. They are called major cardiovascular events (MCE). Non-pharmacological (non-drug therapy) options such as losing weight, increasing exercise, improving diet and decreasing salt intake are important lifestyle factors in managing HBP. BP medication use is an important factor in helping people achieving target BP levels.

There have been trials carried out that indicate that the use of multiple drug regimens and achieving a systolic (BP when the heart beats) BP of under 120mmHg led to a decrease in complications relating to cardiovascular disease (CVD). However, there has been little research carried out on the effectiveness of certain drug types on the risk of CVD in these patients.

Thiazides are a type of diuretic drug. It works by increasing the production of urine. This leads to a decrease in BP. The effectiveness of thiazide use regarding a decrease in CVD in patients receiving intense HBP treatment remains under investigation.

There were 2847 patients receiving intensive treatment for HBP. 1810 patients were taking thiazides and 1037 patients were not taking thiazides. The average follow-up period was 3.3 years. 

The risk of patients having a MCE was 42% lower in the thiazide group when compared to the group not taking a thiazide. The risk of having a stroke was 33% lower for patients taking thiazides compared to the non-thiazide group. The risk of having a heart attack was 50% lower in the thiazide group compared to the non-thiazide group.

The risk of having heart failure was decreased by 91% in the thiazide group when compared to patients not taking a thiazide medication. All-cause death was significantly decreased by 70% in the thiazide group compared to the non-thiazide group. 

The rate of having side effects was similar in both groups. The most common side effects that occurred in the thiazide group were low potassium levels.

The authors concluded that thiazide use decreased the risk of cardiovascular events, particularly in high-risk patients receiving intensive HBP treatment. 

This study did not assess differences in particular thiazides which should be carried out in a future study.