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 ) .
Mortality and treated blood pressure in patients of the European Working Party on High Blood Pressure in the Elderly.
Elderly hypertensive patients were r and omly assigned to treatment with diuretics and methyldopa  ( n = 352 ) or placebo ( n = 339 ) , and divided into three groups , each according to their blood pressures , after nine months of treatment . Subsequently , 65 placebo patients and 56 treated patients died . A U-shaped relation was seen in treated patients between mortality and systolic blood pressure , and in placebo patients between mortality and diastolic blood pressure . Whereas in treated patients , the highest mortality was seen in patients with the lowest diastolic pressure , the lowest mortality was seen in the group with the highest diastolic pressure . The increased mortality in treated patients with the lowest blood pressure may not be drug-induced , but an expression of deterioration in general health , as indicated by the decreases in body weight and hemoglobin levels found in patients with the lowest blood pressures in previous analyses of these data
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 ) .