Previous work comparing safety and effectiveness outcomes for new initiators of angiotensin converting-enzyme inhibitors (ACEi) and thiazides demonstrated more favorable outcomes for thiazides, although cohort definitions allowed for addition of a second antihypertensive medication after a week of monotherapy. Here, we modify the monotherapy definition, imposing exit from cohorts upon addition of another antihypertensive medication. We determine hazard ratios (HR) for 55 safety and effectiveness outcomes over six databases and compare results to earlier findings. We find, for all primary outcomes, statistically significant differences in effectiveness between ACEi and thiazides were not replicated (HRs: 1.11, 1.06, 1.12 for acute myocardial infarction, hospitalization with heart failure and stroke, respectively). While statistical significance is similarly lost for several safety outcomes, the safety profile of thiazides remains more favorable. Our results indicate a less striking difference in effectiveness of thiazides compared to ACEi and reflect some sensitivity to the monotherapy cohort definition modification.

中文翻译：

---

严格单一疗法下血管紧张素转换酶抑制剂与噻嗪类和噻嗪类利尿剂的安全性和有效性比较

先前的研究比较了血管紧张素转换酶抑制剂（ACEi）和噻嗪类新引发剂的安全性和有效性结果，结果表明噻嗪类药物的结果更有利，尽管队列定义允许在单一治疗一周后添加第二种抗高血压药物。在这里，我们修改了单一疗法的定义，在添加另一种抗高血压药物后强制退出队列。我们确定了六个数据库中 55 种安全性和有效性结果的风险比 (HR)，并将结果与​​早期的发现进行比较。我们发现，对于所有主要结局，ACEi 和噻嗪类药物之间的有效性没有重复统计学上的显着差异（急性心肌梗死、心力衰竭住院和中风的 HR 分别为 1.11、1.06、1.12）。虽然一些安全结果同样失去了统计显着性，但噻嗪类药物的安全性仍然更有利。我们的结果表明，与 ACEi 相比，噻嗪类药物的有效性差异不太显着，并且反映了对单一疗法队列定义修改的一些敏感性。