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Medical records of hypertensive adults initiating nebivolol, hydrochlorothiazide, metoprolol, or amlodipine as first add\u2010on therapy between December 16, 2010 and July 21, 2011 were retrospectively abstracted (N\u00a0=\u00a01600; 400\/treatment). Outcomes included medication\u2010related side\u2010effect rates and blood pressure (<jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>) reduction and control. Compared with nebivolol, metoprolol and amlodipine had significantly higher side\u2010effect rates (incidence rate ratio [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]: 1.82 [1.14\u20102.92] and 2.67 [1.69\u20104.21]), respectively); the hydrochlorothiazide\u2010nebivolol rate ratio was not significant (1.61 [0.95\u20102.71]). All treatments reduced <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> at 2\u00a0months. Metoprolol, amlodipine, and hydrochlorothiazide were associated with significantly lower odds of achieving 2\u2010month <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> control than nebivolol (odds ratios [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]: 0.34 [0.23\u20100.51], 0.51 [0.35\u20100.75] and 0.66 [0.44\u20100.99], respectively). In a real\u2010world setting, nebivolol as first add\u2010on therapy was associated with fewer side effects than metoprolol or amlodipine and with a higher <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> control rate than hydrochlorothiazide, metoprolol, or amlodipine.<\/jats:p>","DOI":"10.1111\/jch.13312","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T20:09:31Z","timestamp":1529006971000},"page":"1058-1066","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A retrospective study evaluating the tolerability and effectiveness of adjunctive antihypertensive drugs in patients with inadequate response to initial treatment"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0870-2309","authenticated-orcid":false,"given":"Rajeev","family":"Ayyagari","sequence":"first","affiliation":[{"name":"Analysis Group  Boston MA 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