Drug Treatment for Hypertension - Related Resources

Cochrane reviews

• First-line CCBs may not be significantly different from any of the other classes of antihypertensive drugs for total mortality. First-line CCBs may have a harmful effect on the outcome of congestive heart failure Calcium Channel Blockers Versus other Classes of Drugs for Hypertension.
• Beta-blockers as first-line drugs in hypertension appear not to reduce total mortality or the risk of coronary heart disease but may lead to modest reductions in the risk of stroke as compared to placebo or no treatment. There is a trend towards worse outcomes with beta-blockers in comparison with calcium-channel blockers, renin-angiotensin system inhibitors and thiazide diuretics. Conclusions are mainly based on trials with atenolol.Beta-Blockers for Hypertension.
• Cardioselective betablockers appear not to produce clinically significant adverse effects in the short term Cardioselective Betablockers in Patients with Reversible Airway Disease.

Other evidence summaries

Drug therapy

• Benefits of treatment of elevated blood pressure are documented in patients with diastolic blood pressure above 95 mmHg and in the elderly with systolic blood pressure above 160 mmHg. Only pharmacological interventions have shown an effect on morbidity and mortality. Antihypertensive drugs may reduce all-cause mortality and the risk of fatal coronary events in middle-aged patients with mild-to-moderate hypertension and high baseline mortality risk Improvement of Survival with Antihypertensive Drugs in Mild-to-Moderate Hypertension.
• Antihypertensive treatment reduces left ventricular mass. ACE inhibitors may be more effective than beta-blockers or diuretics Reversal of Left Ventricular Hypertrophy in Essential Hypertension.

ACE inhibitors and ATR blockers

• ACE inhibitors reduce the risk of myocardial infarction, cardiovascular events and all-cause mortality in hypertensive patients with type 2 diabetes ACE Inhibitors and other Antihypertensive Drugs in Patients with Type 2 Diabetes.
• Losartan appears to be more effective than atenolol in reducing cardiovascular morbidity and mortality as well as mortality from all causes in patients with hypertension, diabetes, and LVH Losartan Versus Atenolol for Diabetic Hypertensive Patients with LVH.

Diuretics

• Non-potassium sparing diuretics may be associated with a slight increase in the incidence of sudden cardiac death in hypertensive patients Non-Potassium Sparing Diuretics and Risk of Sudden Death.

Calcium antagonists

• Calcium channel blockers are as safe as beta blockers with respect to serious adverse effects. Headache and oedema are more common with calcium channel blockers than with diuretics, and flushing are more common with calcium channel blockers than with beta blockers Adverse Effects of Hypertensive Agents.

Beta-blockers

• Beta-blocker (mostly atenolol) treatment for primary hypertension is associated with a higher risk of stroke than treatment with other antihypertensive agents. Compared with placebo, beta-blockers reduce the risk of stroke by 19%, which is about half that expected from previous hypertension trials Beta-Blockers Against other Antihypertensive Drugs.

Clinical guidelines

• Authors/Task Force Members, Mancia G, Fagard R et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013 [Epub ahead of print]. [PubMed]
• National Institute for Health and Clinical Excellence (NICE). Hypertension: management of hypertension in adults in primary care. Clinical guideline CG127, 2011http://www.nice.org.uk/CG127

Literature

• Aronow WS, Fleg JL, Pepine CJ et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2011;123(21):2434-506.[PubMed]
• Gradman AH, Basile JN, Carter BL et al. Combination therapy in hypertension. J Am Soc Hypertens 2010;4(1):42-50.[PubMed]
• Ernst ME, Moser M. Use of diuretics in patients with hypertension. N Engl J Med 2009 Nov 26;361(22):2153-64. [PubMed]