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 ) .
Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on High Blood Pressure in the Elderly.
OBJECTIVE --To investigate the relation between mortality and treated systolic and diastolic blood pressures . DESIGN --R and omised double blind placebo controlled trial . Mortality in the two treatment groups was examined in thirds of treated systolic and diastolic blood pressures . PATIENTS --339 And 352 patients allocated to placebo and active treatment , respectively .  The groups were similar at r and omisation in sex ratio ( 70 % women ) , mean age ( 71.5 years ) , blood pressure ( 182/101 mm Hg ) , and proportion of patients with cardiovascular complications ( 35 % ) . MEASUREMENTS AND MAIN RESULTS --In the placebo group total mortality rose with increasing systolic pressure whereas it had a U shaped relation with diastolic pressure , the total lowest mortality being in patients in the middle third of the distribution of diastolic pressure . In the group given active treatment  total mortality showed a U shaped relation with systolic pressure and an inverse association with treated diastolic pressure . In both groups cardiovascular and non-cardiovascular mortality followed the same trends as total mortality . The increased mortality in the lowest thirds of pressure was not associated with an increased proportion of patients with cardiovascular complications at r and omisation or with a fall in diastolic pressure exceeding the median fall in pressure in each group . In contrast , patients in the lowest thirds of pressure showed greater decreases in body weight and haemoglobin concentration than those in the middle and upper thirds of pressure . CONCLUSIONS --In patients taking active treatment  total mortality was increased in the lowest thirds of treated systolic and diastolic blood pressures . This increased mortality is not necessarily explained by an exaggerated reduction in pressure induced by drugs as for diastolic pressure a U shaped relation also existed during treatment with placebo . In addition , patients in the lowest thirds of systolic and diastolic pressures were characterised by decreases in body weight and haemoglobin concentration , and the patients in the lowest thirds of diastolic pressure taking active treatment also by an increased non-cardiovascular mortality , suggesting some deterioration of general health
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 ) .