Thiazides Might Be Less Cardioprotective in Lean Than in Overweight Hypertensive Patients

In several studies of patients with hypertension, obese patients have exhibited lower rates of adverse cardiovascular (CV) events than their nonobese counterparts. Does this “obesity paradox” vary with different antihypertensive therapies? In the 3-year, industry-sponsored ACCOMPLISH trial, patients with hypertension and additional CV risk factors who were randomized to receive benazepril and amlodipine had fewer adverse CV events (CV-related deaths or nonfatal myocardial infarctions or strokes) than those who received benazepril and hydrochlorothiazide. In a new analysis, investigators examined adverse CV event rates in this trial after categorizing participants by body-mass index (BMI).

The overall incidence of adverse CV events was signif…