Relative efficacy of, and some adverse reactions to, different antihypertensive regimens

Although it is a common belief that all antihypertensive agents are equally effective in reducing blood pressure, there is some evidence to the contrary, both in the general population and when specific patient demographics are considered. In black patients, beta blockers and angiotensin-converting enzyme (ACE) inhibitors have been shown to be less effective at reducing blood pressure than the thiazide diuretics. After age 60, the percentage of responders to beta blockers is less than with calcium antagonists, and a higher percentage of elderly patients also achieve normotensive blood pressure levels with diuretic therapy than with beta blockers. When a thiazide diuretic is added to an ACE inhibitor, beta blocker or calcium antagonist, the number of normotensive responders increases significantly. Combinations of some other agents (i.e., an ACE inhibitor plus a beta blocker) may not, however, improve efficacy. Diuretics, beta blockers and ACE inhibitors are all generally well tolerated, with a 9 to 10% incidence of subjective side effects. The use of calcium antagonists and especially the centrally acting adrenergic inhibitors may result in more frequent adverse effects. Data from long-term, diuretic-based clinical trials do not support the statement that diuretic therapy results in sustained elevations in lipid levels. These trials have shown cholesterol levels to be at or below baseline after long-term diuretic therapy. The use of beta blockers, on the other hand, may result in long-term elevation of triglyceride levels and a slight decrease in high-density lipoprotein cholesterol. Calcium antagonists and ACE inhibitors do not affect lipid levels, and alpha blockers may actually lower cholesterol levels and increase high-density lipoprotein levels.(ABSTRACT TRUNCATED AT 250 WORDS)