また、ALLHAT研究以降降圧利尿剤の評価高くなってたはずだが・・・｢高血圧診療専門家｣たちがことごとく無視（糖尿病分野のメトホルミンを見ているようだ・・・）
ダイクロトライドを販売中止に追い込んだ高血圧専門家たち
https://intmed.exblog.jp/9797784/
この報告見ると、約10年ぶりに、再度怒りがこみ上げてくる
高血圧専門家たちが、その後バルサルタン関連事件に関与してるわけで、腐ってますな！
LEGEND-HTN study
Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis
Prof Marc A Suchard, et al.
Published:October 24, 2019
DOI:https://doi.org/10.1016/S0140-6736(19)32317-7
https://www.thelancet.com/journals/lancet/artic0-636(19)32-7/fulltext
490万名の患者データを用い、22,000キャリブレート作成propensity score 補正ハザード比を全てのクラス薬剤とアウトカムをデータベース横断的に比較
多くの有効性推定検定でクラス間の有効性の差を認めず
ただ、サイアザイド或いはサイアザイド様利尿剤はACE阻害剤より一次有効性優れていた
初期治療中
- 急性心筋梗塞 HR 0·84, 95% CI 0·75–0·95
- 心不全入院 0·83, 0·74–0·95
- 卒中 0·83, 0·74–0·95
安全性特性もまたサイアザイド及びサイアザイド様利尿剤は、ACE阻害剤を上回る
非DHPカルシウム遮断剤は他の４つのクラスに比べ有意に劣性
（ジルチアゼム/へルベッサーが非DHPの代表 他： phenylalkylamines (verapamil)・・・ https://www.ncbi.nlm.nih.gov/books/NBK10474/）
Figure 1: Comparative effectiveness of THZs, ACEis, ARBs, dCCBs, and ndCCBs Points report hazard ratio (HR) estimates and lines mark their 95% CIs. HRs of less than 1 favour target (row) over comparator (column).
(A) Meta-analytic risk estimates across all nine effectiveness outcomes with primary outcomes in orange and secondary outcomes in blue.
(B) Cardiovascular event risk estimates by data source and meta-analysis.
Colours identify databases; the top block are administrative claims databases, the middle block are electronic health records and black highlights a meta-analysis across all other sources. Not all databases contain sufficient new users for study inclusion.
Cardiovascular event is a composite outcome of acute myocardial infarction, hospitalisation for heart failure, stroke, and sudden cardiac death.
ACEi=angiotensin converting-enzyme inhibitors. ARB=angiotensin receptor blockers. dCCB=dihydropyridine calcium channel blockers. ndCCB=non-dihydropyridine calcium channel blockers. THZ=thiazide or thiazide-like diuretics. HR=hazard ratio. CCAE=IBM MarketScan Commercial Claims and Encounters. Optum=Optum ClinFormatics. MDCR=IBM MarketScan Medicare Supplemental Beneficiaries. MDCD=IBM MarketScan Multi-state Medicaid. JMDC=Japan Medical Data Center. NHIS/NSC=South Korea National Health Insurance Service/National Sample Cohort. PanTher=Optum Pan-Therapeutic. IMSG=IMS/IQVIA Disease Analyzer Germany. CUMC=Columbia University Medical Center.
