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 ) .
The systolic hypertension in the elderly pilot program: methodological issues.
The Systolic Hypertension in the Elderly Program ( SHEP ) Pilot Study was conducted to determine the feasibility of conducting a long-term placebo-controlled r and omized clinical trial in elderly subjects . Enrolled in the study were 551 men and women between the ages of 60 and 90 years with isolated systolic hypertension ( SBP greater than or equal to 160 mmHg and DBP less than 90 mmHg ) . The study showed that it is possible to recruit old and very old subjects into a clinical trial ; the elderly are good compliers ( drugs and follow-up visits ) , with some decline after the age of 80 ; control of blood pressure was accomplished in the large majority of patients ; evaluation of side effects represents a potential problem as varied complaints increase with age thus creating difficulties in distinguishing those attributed to the study drug ; and finally , cause-specific mortality is probably preferable to all-cause mortality as an end-point in prevention trials of antihypertensive regimens
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 ) .