First-line low-dose thiazides reduce all morbidity and mortality outcomes .
First-line ACE inhibitors and calcium channel blockers may be similarly effective but the evidence is less robust .
First-line high-dose thiazides and first-line beta-blockers are inferior to first-line low-dose thiazides
BACKGROUND Sustained elevated blood pressure , unresponsive to lifestyle measures , leads to a critically important clinical question : What class of drug to use first-line ?
This review answers that question .
OBJECTIVES PRIMARY OBJECTIVE To quantify the benefits and harms of the major first-line anti-hypertensive drug classes : thiazides , beta-blockers , calcium channel blockers , angiotensin converting enzyme ( ACE ) inhibitors , alpha-blockers , and angiotensin II receptor blockers ( ARB ) .
Risks and benefits in the trial of the European Working Party on High Blood Pressure in the Elderly.
Hypertensive patients over the age of 60 years were admitted to a double-blind placebo-controlled trial . Patients in the actively treated group received a combined potassium-losing and -sparing diuretic ( triamterene 50 mg plus hydrochlorothiazide 25 mg ; n = 416 ) ; this dose could be doubled and methyldopa ( up to 2 g , daily ) was added in 35 % of patients when blood pressure remained high . The placebo group ( n = 424 ) received matching capsules and tablets . Adverse effects were assessed in the double-blind period of the trial by calculating the incidence of abnormal biochemical results , investigator reports of diseases and prescriptions of concomitant therapy and a self-administered symptom question naire completed by patients . In 1000 hypertensive subjects over 60 years of age , 1 year of active treatment would prevent 11 fatal cardiac events , 6 fatal and 11 non-fatal strokes and 8 cases of severe congestive heart failure . No unexpected adverse treatment effects were observed . A significant excess incidence rate ( per 1000 person years ) was found in the active group compared with placebo for : ( 1 ) impaired renal function , a serum creatinine greater than 180 mumol/l ( 2.0 mg/dl ) ; ( 2 ) mild hypokalaemia , a serum potassium less than 3.5 mmol/l ; ( 3 ) reports of gout ; and ( 4 ) an elevated serum uric acid greater than 0.52 mmol/l in men or greater than 0.46 in women . Elevated blood sugar and prescriptions for hypoglycaemic drugs tended to be more frequent in the actively treated group , but this difference was not statistically significant . In both groups , there was a low incidence ( less than 7 per 1000 person years ) of anaemia and depression and diseases of the liver , gall bladder or pancreas . ( ABSTRACT TRUNCATED AT 250 WORDS
First-line low-dose thiazides reduce all morbidity and mortality outcomes .
First-line ACE inhibitors and calcium channel blockers may be similarly effective but the evidence is less robust .
First-line high-dose thiazides and first-line beta-blockers are inferior to first-line low-dose thiazides
BACKGROUND Sustained elevated blood pressure , unresponsive to lifestyle measures , leads to a critically important clinical question : What class of drug to use first-line ?
This review answers that question .
OBJECTIVES PRIMARY OBJECTIVE To quantify the benefits and harms of the major first-line anti-hypertensive drug classes : thiazides , beta-blockers , calcium channel blockers , angiotensin converting enzyme ( ACE ) inhibitors , alpha-blockers , and angiotensin II receptor blockers ( ARB ) .