Which blood pressure medication is best for patients with high blood pressure but no heart disease?

This study compared calcium channel blockers (CCBs) and angiotensin receptor blockers (ARBs) as the first type of medications for hypertension (high blood pressure; BP). They found that patients treated with ARBs were less likely to suffer from heart attacks, stroke, or death than patients treated with CCBs.

Hypertension is a common condition. If not treated, it can lead to major cardiovascular events (MACE) such as heart attacks, strokes, or even death due to heart disease. CCBs and ARBs are both commonly used BP-lowering medications. It is not clear which is more effective at preventing a heart attack, stroke, or death in the long-term in patients with hypertension but without heart disease. 

This study reviewed the records of 464,948 patients with high BP. Only patients who had no history of heart attack, heart failure, or stroke were included. 200,728 patients were treated with ARBs. 262,220 patients were treated with CCBs. Patient records were reviewed after 3 years to see how many had suffered MACEs such as heart attacks, strokes, or death.

In the ARB group, MACEs occurred in 5.2% of patients. In the CCB group, MACEs occurred in 7.3% of patients. Patients in the ARB group were more likely to be male, have higher incomes, have diabetes or kidney disease. Statistical tests were done to account for these differences. When differences between the groups were accounted for, the ARB group had a 4% lower risk of heart attack, stroke, or death than the CCB group.

This study showed that patients with hypertension and no heart problems have a lower risk of heart attack, stroke, or death when treated with ARBs than CCBs.

This study was based on medical records in an Asian population. More studies are needed to confirm these findings and see if they apply to other ethnicities.