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Adult hypertension: reducing cardiovascular morbidity and mortality

    Prescrire International
    |March 9, 2005
    PubMed

    Insights

    Thiazide diuretics are recommended as a first-line treatment for hypertension, including in patients with diabetes or a history of stroke. The primary goal of treatment is to reduce cardiovascular events and mortality.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Internal Medicine

    Background:

    • Arterial hypertension management has evolved since 1999 with new data and antihypertensive drugs.
    • The working definition of hypertension remains unchanged, requiring consistent readings of at least 160/95 mm Hg (or 140/80 mm Hg for specific patient groups).

    Purpose of the Study:

    • To review current treatments for arterial hypertension.
    • To evaluate the risk-benefit balance of drug and non-drug interventions.
    • To identify first-line and alternative antihypertensive therapies.

    Main Methods:

    • Review of published data and clinical endpoint trials.
    • Assessment of antihypertensive drug efficacy and safety.
    • Comparison of various drug classes including diuretics, beta-blockers, ACE inhibitors, and others.

    Main Results:

    • Thiazide diuretics (chlortalidone, hydrochlorothiazide) are supported as first-line treatment for most hypertensive patients.
    • Beta-blockers and angiotensin-converting-enzyme inhibitors (ACE inhibitors) are identified as second-line alternatives.
    • Other antihypertensives like calcium channel blockers and angiotensin II antagonists are available but less extensively evaluated than thiazides.

    Conclusions:

    • Antihypertensive therapy should prioritize reducing mortality and cardiovascular events over fixed blood pressure thresholds.
    • Initiating treatment with a single drug is recommended when pharmacotherapy is necessary.
    • Thiazide diuretics offer a favorable long-term risk-benefit profile for initial hypertension management.

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