Are there benefits to specific antihypertensive drug therapy?
The antihypertensive drug classes that have reduced cardiovascular events safely either in large placebo-controlled trials or in comparison with other effective antihypertensive drugs in large morbidity trials are diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs). Although control of blood pressure (BP) is a primary goal of therapy, evidence from several clinical trials suggests that certain antihypertensive agents provide clinical benefits independent of their effect on BP. In the recently reported Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), an ACE inhibitor, a CCB, and an alpha-blocker reduced coronary events and mortality to a similar extent as a thiazide-type diuretic, but the diuretic reduced one or more major cardiovascular events, especially heart failure, more than the other agents. In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) trial, the ARB losartan reduced cardiovascular morbidity (primarily stroke) more than the beta-blocker atenolol. Although an ARB has not yet been compared with a diuretic in a morbidity trial, as most patients require more than one drug to control BP, and a diuretic plus an ARB is a very effective and well-tolerated combination, this uncertainty applies to a minority of patients. A primary goal in treating hypertension should be to reach a patient's goal BP, but initial selection of drugs based on hypertension morbidity study results and other compelling indications should be given priority.
Cushman
William C
WC
University of Tennessee College of Medicine, Memphis, Tennessee 38104, USA. wcushman@pol.net
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics