First-Line Therapy for Hypertension
Authors: Mohsen S. Eledrisi
Journal: Annals of Internal Medicine (2007)

Letters17 April 2007First-Line Therapy for HypertensionMohsen S. Eledrisi, MDMohsen S. Eledrisi, MDFrom King Abdulaziz National Guard Medical Center, Alahsa, Saudi Arabia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-8-200704170-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: In the recent Update in Cardiology (1), Rapaport draws conclusions from the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) (2) and recommends that physicians consider “using amlodipine as a first-line antihypertensive in patients with ≥3 other cardiovascular risk factors.” This should be interpreted carefully. The ASCOT-BPLA investigators found no difference in the study's primary outcome and observed the reported benefits in secondary end points. In addition, several issues were raised about the design of the trial. First is the choice of a β-blocker as a comparator for first-line therapy versus amlodipine. Ever since the Medical Research ...References1. Rapaport E. Update in cardiology. Ann Intern Med. 2006;145:618-25. [PMID: 17043343] LinkGoogle Scholar2. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895-906. [PMID: 16154016] MedlineGoogle Scholar3. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ. 1992;304:405-12. [PMID: 1445513] CrossrefMedlineGoogle Scholar4. Danchin N, Cucherat M, Thuillez C, Durand E, Kadri Z, Steg PG. Angiotensin-converting enzyme inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction: an overview of long-term randomized, controlled trials. Arch Intern Med. 2006;166:787-96. [PMID: 16606817] CrossrefMedlineGoogle Scholar5. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-97. [PMID: 12479763] CrossrefMedlineGoogle Scholar6. Wright JT, Dunn JK, Cutler JA, Davis BR, Cushman WC, Ford CE, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005;293:1595-608. [PMID: 15811979] CrossrefMedlineGoogle Scholar7. Khan NA, McAlister FA, Rabkin SW, Padwal R, Feldman RD, Campbell NR, et al. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II—Therapy. Can J Cardiol. 2006;22:583-93. [PMID: 16755313] CrossrefMedlineGoogle Scholar8. Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA. 2003;289:2534-44. [PMID: 12759325] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Mohsen S. Eledrisi, MDAffiliations: From King Abdulaziz National Guard Medical Center, Alahsa, Saudi Arabia.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUpdate in Cardiology Elliot Rapaport Metrics 17 April 2007Volume 146, Issue 8Page: 615KeywordsACE inhibitorsAntihypertensive drug therapyCardiovascular diseasesCardiovascular therapyConflicts of interestDiureticsHypertensionMedical risk factorsMorbidityMortality ePublished: 17 April 2007 Issue Published: 17 April 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...