Which drug should be used to treat patients with uncomplicated essential hypertension?
OBJECTIVE
To review recent data and guidelines on selecting the initial antihypertensive drug.


RESULTS
The main driver of benefit from blood pressure-lowering therapy is blood pressure reduction, and there is little evidence supporting additional drug class-specific benefits in primary prevention of major cardiovascular outcomes. The results also confirm that in the patient with uncomplicated hypertension as well as in those patients with diabetes without nephropathy, initial therapy with 'newer therapies' (i.e. angiotensin-converting enzyme inhibitors, calcium channel blockers, and angiotensin receptor blockers) are effective, but not more effective than thiazide diuretics, at reducing stroke, coronary heart disease, morbidity or mortality, or all-cause mortality.


CONCLUSIONS
While compelling indications may exist for specific drug classes in those with specific target organ damage (i.e. heart failure, renal insufficiency, and coronary artery disease), thiazide diuretics remain unsurpassed in lowering blood pressure and in preventing hypertension-related clinical outcomes. Despite a more favorable metabolic profile, alpha-blockers are less effective in preventing cardiovascular disease, especially heart failure and stroke. Calcium channel blockers produce a similar reduction in blood pressure and cardiovascular disease outcomes compared with thiazide-type diuretics, although they are consistently less effective in preventing heart failure. In the absence of heart failure or renal disease, angiotensin-converting enzyme inhibitors have shown little advantage in clinical trials over diuretics in preventing cardiovascular disease and are not indicated as an initial therapy in Blacks.
Rashidi
Arash
A
Division of Nephrology and Hypertension, University Hospitals of Cleveland, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, OH 44106-5401, USA.
Rahman
Mahboob
M
Wright
Jackson T
JT
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D017410:Practice Guidelines as Topic
D000959:Antihypertensive Agents