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 of treatment of systolic hypertension in aged subjects. An initial report].
Syst-Eur is a multicentre placebo-controlled outcome trial , design ed by the European Working Party on High Blood Pressure in the Elderly ( EWPHE ) , 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 mmHg with a diastolic blood pressure less than 95 mmHg . The present paper in 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 + /- st and ard deviation ) , sitting blood pressure ( 178 + /- 12/85 + /- 7 mmHg ) , percentage men ( 34 % ) and percentage of patients with cardiovascular complications ( 29 % ) . After r and omization blood pressure fell more ( p < 0.001 ) on active treatment than in the placebo group ( 19 + /- 20/6 + /- 10 mmHg versus 7 + /- 19/1 + /- 10 mmHg for the 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 2 treatment groups can be achieved and maintained . New centres 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 ) .