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 ) .
Adverse treatment effects in the trial of the European Working Party on High Blood Pressure in the Elderly.
Adverse treatment effects were assessed in 840 elderly hypertensive patients r and omly assigned to active treatment  ( a combination of triamterene and hydrochlorothiazide ) or placebo ; methyldopa was added to the regimen in one third of the treated patients . Symptoms of dry mouth , nasal stuffiness , and diarrhea were reported by significantly more treated patients than placebo control subjects . More patients receiving diuretics plus methyldopa than diuretics alone reported dry mouth and diarrhea . Significantly more treated patients than control subjects showed evidence of a high serum creatinine level , mild hypokalemia , and gout . More treated patients tended to have diabetes . The benefits of treatment outweighed these adverse treatment effects
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 ) .