Drug treatment for hypertension – Related resources

03.06.2016 • Sonuncu dəyişiklik 20.06.2013

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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 .
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..
Cardioselective betablockers appear not to produce clinically significant adverse effects in the short term . There is insufficient evidence on various anti-hypertensive drugs in people with peripheral arterial disease . Reserpine monotherapy may reduce systolic blood pressure roughly to the same degree as other first-line antihypertensive drugs .Methyldopa may lower blood pressure in patients with primary hypertension compared to placebo but there is lack of evidence on its effect on clinical outcomes .

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 .Blood pressure lowering drug therapy reduces the risk of stroke reoccurrence in stroke survivors .
Treatment of non-malignant hypertension with diuretics and adrenergic blockers does not decrease the risk of renal dysfunction .
Antihypertensive treatment reduces left ventricular mass. ACE inhibitors may be more effective than beta-blockers or diuretics .Worksite care, physician education, and electronical vial caps may be effective interventions in improving patient adherence in hypertension care .

ACE inhibitors reduce the risk of myocardial infarction, cardiovascular events and all-cause mortality in hypertensive patients with type 2 diabetes .
All angiotensin II antagonists produce comparable efficacy for hypertension .
Losartan appears to prevent slightly more cardiovascular morbidity than atenolol in patients with LVH .
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 .

Non-potassium sparing diuretics may be associated with a slight increase in the incidence of sudden cardiac death in hypertensive patients .

Nifedipine in sustained- and extended-release formulations appears to be safe when used in combination with other drugs (diuretics or beta-blockers) in patients with mild or moderate hypertension .The risk of serious adverse events, including death and cardiovascular events does probably not differ in hypertensive patients with isradipine or with other active agents .
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 .
An amlodipine-based regimen adding perindopril prevented more major cardiovascular events and induced less diabetes than an atenolol-based regimen adding bendroflumethiazide, although the result was not significant for the primary endpoint (non-fatal myocardial infarction and fatal coronary heart disease (CHD)) .

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 .
The adverse effects of atenolol on plasma lipids appear to be significantly greater than those of celiprolol, enalapril, nifedipine, or doxazosin .

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].
National Institute for Health and Clinical Excellence (NICE). Hypertension: management of hypertension in adults in primary care. Clinical guideline CG127, 2011

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.
Gradman AH, Basile JN, Carter BL et al. Combination therapy in hypertension. J Am Soc Hypertens 2010;4(1):42-50.
Ernst ME, Moser M. Use of diuretics in patients with hypertension. N Engl J Med 2009 Nov 26;361(22):2153-64.