In a nutshell
This study investigated the safety and effectiveness of anti-hypertensive (AHT) drugs used as a first-line treatment (FLT).
They found that thiazide (or thiazide-like) diuretics (TD/TLDs) had better safety and effectiveness than other classes used as FLT.
Some background
Hypertension or high blood pressure (BP) is a very common condition. Managing BP is very important to prevent damage to major organs. BP can be managed by making lifestyle changes. These included diet and exercise. Medication is another method of BP management. Anti-hypertensive (AHT) drugs reduce blood pressure by various mechanisms.
First-line treatment (FLT) in hypertension is usually one of 4 types of drugs. Thiazide (or thiazide-like) diuretics (TD/TLDs) reduce BP by decreasing the volume of blood in the vessel. Angiotensin-converting enzymes (ACE) inhibitors (ACEi) cause blood vessels to dilate (enlarge). This reduces BP. Angiotensin receptor blockers (ARB) also cause vessel dilation. Calcium channel blockers (CCBs) cause the arteries to dilate and BP is reduced. It is important to identify the most suitable FLT for patients with hypertension. A regular review of scientific reports is needed.
Methods & findings
This study included data from 4.9 million patients with hypertension. Patient records were obtained from 6 insurance claims databases and 3 medical record databases. The authors analyzed the type of AHT drug used as FLT. They compared the safety and effectiveness of these drugs as FLTs. Heart attack and stroke were used as the outcomes for effectiveness.
TD/TLDs had improved effectiveness over ACEi. TD/TLDs treatment was associated with a 16% lower rates of heart attack. The rate of heart failure and stroke was also 17% lower compared to ACEi. Dihydropyridine CCBs (DHP-CCBs) had better outcomes than non-DHP-CCBs. Safety outcomes were better with TD/TLDs than ACEi. DHP-CCBs had worse safety outcomes compared to all other drug types.
The bottom line
The authors concluded that TD/TLDs had better safety and effectiveness as FLT in patients with hypertension.
The fine print
This study was based on medical records. Patients were treated according to their doctor’s preference. Patients with lower BP may have been treated with TD/TLDs. This could bias the results of the study. More controlled studies are needed to confirm the results.
What’s next?
If you have any concerns regarding hypertension management please consult with your doctor.
Published By :
Lancet (London, England)
Date :
Oct 24, 2019
