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 ) .
Syst‐Eur—A Multicenter Trial on the Treatment of Isolated Systolic Hypertension in the Elderly: First Interim Report
Syst-Eur is a multicenter placebo-controlled outcome trial design ed by the European Working Party on High Blood Pressure in the Elderly to investigate the effect of antihypertensive treatment on the incidence of stroke in elderly patients with isolated systolic hypertension ( ISH ) . Eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160 - 219 mm Hg with a diastolic blood pressure less than 95 mm Hg . The present paper is an interim report on the first 316 patients r and omized into this trial . The placebo ( n = 170 ) and active treatment ( n = 146 ) groups were similar at r and omization with respect to age ( 73 + /- 8 years ; mean + /- SD ) , sitting blood pressure ( 178 + /- 12 mm Hg systolic ; 85 + /- 7 mm Hg diastolic ) , percentage of men ( 34 % ) , and percentage of patients with cardiovascular complications ( 29 % ) . After r and omization blood pressure fell more ( p less than 0.001 ) in patients on active treatment than in those in the placebo group ( 19 + /- 20 mm Hg systolic ; 6 + /- 10 mm Hg diastolic vs. 7 + /- 19 and 1 + /- 10 mm Hg for sitting blood pressure ) . This first interim report on the Syst-Eur trial demonstrates that a multinational trial in elderly patients with ISH is feasible and that a significant blood pressure difference between the two treatment groups can be achieved and maintained . New centers are being recruited in order to r and omize a total of 3,000 patients
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 ) .