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 ) .
Long term effects of nisoldipine on the progression of coronary atherosclerosis and the occurrence of clinical events: the NICOLE study
Background : Earlier angiographic studies have suggested that calcium antagonists may prevent the formation of new coronary lesions and the progression of minimal lesions . Conversely , a meta- analysis suggested that these drugs may increase cardiovascular mortality and morbidity in patients with coronary heart disease . Objective : To investigate whether nisoldipine retards the progression of coronary atherosclerosis or reduces the occurrence of clinical events . Design and setting : The NICOLE study ( NIsoldipine  in COronary artery disease in LEuven ) is a single centre , r and omised , double blind , placebo controlled trial with coronary angiography at baseline , six months , and three years of follow up . Patients : 826 patients who had undergone successful coronary angioplasty were r and omised to nisoldipine 40 mg once daily or placebo . The intention to treat and per protocol population consisted of 819 and 578 patients , respectively . Results : In the per protocol population , 625 of the nisoldipine treated and 655 of the placebo treated patients ( NS ) showed angiographic progression in at least one coronary arterial segment , defined as an increase in diameter stenosis of ≥ 13 % . The average minimum luminal diameter of the non-dilated lesions decreased by 0.163 mm and 0.167 mm in the nisoldipine and placebo groups , respectively ( NS ) . The respective numbers of new lesions detected were 7 and 13 ( NS ) . In the intention to treat population , the rates of death , stroke , and acute myocardial infa rct ion were similar in both treatment groups . However , nisoldipine use was associated with fewer revascularisation procedures and thus the percentage of patients with any clinical event was lower ( 44.6 % v 52.6 % , p = 0.02 ) . Conclusions : Nisoldipine has no demonstrable effect on the angiographic progression of coronary atherosclerosis or the risk of major cardiovascular events but its use is associated with fewer revascularisation procedures
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 ) .