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 ) .
Body mass index and prognosis in elderly hypertensive patients: a report from the European Working Party on High Blood Pressure in the Elderly.
Obesity and hypertension are often found in the same patients , particularly in elderly women . However , few data on the joint impact of these two conditions in women and the elderly are available . In the current study of 800 elderly hypertensive patients r and omly assigned to active treatment or placebo , the initial mean body mass index ( BMI ) was 26.7 kg/m2 in 560 women and 25.7 kg/m2 in 240 men . During the trial , total mortality and cardiovascular and noncardiovascular terminating events were highest in the patients at the leanest BMI quintile . The association between BMI and cardiovascular end points was U-shaped , whereas noncardiovascular mortality decreased with increasing BMI . The results in the women were similar to those in the total group . The U-shaped relation was confirmed with Cox 's proportional hazards model , controlling for age , gender , systolic blood pressure , hemoglobin , serum cholesterol , blood glucose , and cardiovascular complications at entry . The BMI level with the lowest risk was 28 to 29 kg/m2 for total mortality and cardiovascular terminating events , 26 to 27 kg/m2 for cardiovascular mortality , and 31 to 32 kg/m2 for noncardiovascular mortality . BMI did not modify the favorable effects of drug treatment . There was no evidence that obesity would protect elderly hypertensive men or women from cardiovascular complications
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 ) .