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 ) .
Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS).
BACKGROUND Questions regarding the efficacy of nonpharmacologic approaches for the treatment of stage 1 hypertension were addressed as part of the Treatment of Mild Hypertension Study ( TOMHS ) , a 4-year , r and omized clinical trial ( N = 902 ) . This report describes the lifestyle intervention program used in TOMHS , presents data on the lifestyle changes observed , and focuses on the effect of weight loss on blood pressure and blood lipid levels . METHODS Participants were r and omly assigned to receive either placebo or one of five different antihypertensive medications . All took part in a lifestyle intervention program to reduce weight and sodium and alcohol intake  and to increase physical activity .  RESULTS Substantial changes from baseline levels were achieved for all lifestyle intervention variables . Mean weight change was -10.5 lb ( -5.6 % ) at 1 year , -8.5 lb ( -4.5 % ) at 2 years , -7.4 lb ( -4.0 % ) at 3 years , and -5.7 lb ( -3.0 % ) at 4 years . At 4 years , 70 % of participants remained below baseline weight and 34 % maintained a weight loss of 10 lb or greater . Mean change in urinary sodium excretion was -12.5 mmol/8 hr ( -23 % ) at 1 year , -10.7 mmol/8 hr ( -20 % ) at 2 years , -8.4 mmol/8 hr ( -16 % ) at 3 years , and -4.6 mmol/8 hr ( -9 % ) at 4 years . Alcohol intake declined by 1.6 drinks/week among drinkers at 4 years . Reported leisure physical activity increased by 86 % at 1 year and remained 50 % above baseline at 4 years . Beneficial changes in blood pressure and serum lipids were associated with these changes . CONCLUSIONS These results support a role for lifestyle interventions as the initial treatment for stage 1 hypertension and demonstrate that such interventions can be successfully implemented in the clinical setting
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 ) .