#DoesItWorkSummary: Efficacy of First‐line Drugs for Hypertension

By Atanas G. Atanasov


Background: This #DoesItWorkSummary is based on the findings of a Cochrane Systematic Review published in April 2018 [1]. High blood pressure (hypertension) is estimated to be responsible for 7.6 million deaths per year worldwide (13.5% of the total deaths), increasing the risk of life-threatening heart attacks and stroke (around 54% of stroke and 47% of coronary heart disease are due to hypertension) [2]. This makes hypertension to be one of the most important preventable causes of premature death worldwide. One of the most important medical decisions when treating people with high blood pressure is what drug class to use first (first-line therapy). The available options include the following anti-hypertensive drug classes: thiazides (low‐dose or high‐dose), calcium channel blockers, beta‐blockers, ACE inhibitors, angiotensin II receptor blockers, and alpha‐blockers. Systematic evaluation of the existing human trial data was performed to get overview for the efficacy of anti-hypertensive drugs in preventing death and incidence of stroke and coronary heart disease (including myocardial infarction and cardiac death).

DoesItWorkSummary Efficacy of First‐line Drugs for Hypertension

Findings: Analyzed were 24 trials with 58,040 patients [1]. High-quality evidence revealed that first‐line low‐dose thiazides reduced total mortality, stroke, and coronary heart disease in adult patients with moderate to severe primary hypertension. For the other drug classes, the available evidence was moderate-, or low-quality. First‐line ACE inhibitors and calcium channel blockers might be similarly effective to low‐dose thiazides, but the evidence supporting their benefit was of lower quality. High‐dose thiazides and beta‐blockers were inferior to low‐dose thiazides.



1          Wright, J.M., Musini, V.M. and Gill, R. (2018) First-Line Drugs for Hypertension. Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd. https://doi.org/10.1002/14651858.CD001841.pub3.

2          Arima, H., Barzi, F. and Chalmers, J. (2011) Mortality Patterns in Hypertension. Journal of Hypertension, 29, S3–S7. https://doi.org/10.1097/01.hjh.0000410246.59221.b1.


Keywords: #DoesItWorkSummary, efficacy of first‐line drugs for hypertension, heart attacks and stroke,  thiazides, calcium channel blockers, beta‐blockers, ACE inhibitors, angiotensin II receptor blockers, alpha‐blockers, myocardial infarction and cardiac death.


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