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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
First-line drugs for hypertension.
James M Wright1, Vijaya M Musini
1Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3.
The Cochrane Database of Systematic Reviews
|July 10, 2009
Summary
Low-dose thiazides are the most effective first-line treatment for hypertension, reducing mortality and cardiovascular events. High-dose thiazides and beta-blockers are less effective, while ACE inhibitors and calcium channel blockers show promise but require more research.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Sustained elevated blood pressure (hypertension) unresponsive to lifestyle changes necessitates pharmacologic intervention.
- Selecting the optimal first-line antihypertensive drug class is a critical clinical decision.
Purpose of the Study:
- To systematically review and quantify the comparative benefits and harms of major first-line antihypertensive drug classes.
- To evaluate thiazides, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, alpha-blockers, and angiotensin II receptor blockers (ARBs).
Main Methods:
- Comprehensive electronic search of major medical databases (MEDLINE, EMBASE, CINAHL, Cochrane) from January 1966 to June 2008.
- Inclusion of randomized controlled trials (RCTs) of at least one year duration comparing major drug classes against placebo in patients with baseline BP >140/90 mmHg.
- Assessment of outcomes including mortality, stroke, coronary heart disease (CHD), cardiovascular events (CVS), blood pressure reduction, and adverse drug effects.
Main Results:
- Thiazides (19 RCTs) significantly reduced mortality, stroke, CHD, and CVS events. Low-dose thiazides demonstrated efficacy in reducing CHD.
- ACE inhibitors (3 RCTs) showed significant reductions in mortality, stroke, CHD, and CVS events.
- Calcium channel blockers (1 RCT) reduced stroke and CVS events. Beta-blockers (5 RCTs) reduced stroke and CVS events but not CHD or mortality. No RCTs were found for ARBs or alpha-blockers.
Conclusions:
- First-line low-dose thiazides are recommended for reducing overall morbidity and mortality in hypertension.
- ACE inhibitors and calcium channel blockers may offer similar benefits, but require further robust evidence.
- High-dose thiazides and beta-blockers are less effective than low-dose thiazides as first-line therapy.
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