Are There Benefits to Specific Antihypertensive Drug Therapy?

Research output: Contribution to journalArticle

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Abstract

The antihypertensive drug classes that have reduced cardiovascular events safely either in large placebo-controlled trials or in comparison with other effective antihypertensive drugs in large morbidity trials are diuretics, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs). Although control of blood pressure (BP) is a primary goal of therapy, evidence from several clinical trials suggests that certain antihypertensive agents provide clinical benefits independent of their effect on BP. In the recently reported Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), an ACE inhibitor, a CCB, and an α-blocker reduced coronary events and mortality to a similar extent as a thiazide-type diuretic, but the diuretic reduced one or more major cardiovascular events, especially heart failure, more than the other agents. In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) trial, the ARB losartan reduced cardiovascular morbidity (primarily stroke) more than the β-blocker atenolol. Although an ARB has not yet been compared with a diuretic in a morbidity trial, as most patients require more than one drug to control BP, and a diuretic plus an ARB is a very effective and well-tolerated combination, this uncertainty applies to a minority of patients. A primary goal in treating hypertension should be to reach a patient's goal BP, but initial selection of drugs based on hypertension morbidity study results and other compelling indications should be given priority.

Original languageEnglish (US)
JournalAmerican Journal of Hypertension
Volume16
Issue number11 II
StatePublished - Nov 1 2003

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Angiotensin Receptor Antagonists
Diuretics
Antihypertensive Agents
Blood Pressure
Morbidity
Drug Therapy
Losartan
Calcium Channel Blockers
Hypertension
Angiotensin-Converting Enzyme Inhibitors
Sodium Chloride Symporter Inhibitors
Atenolol
Drug and Narcotic Control
Uncertainty
Heart Failure
Stroke
Myocardial Infarction
Placebos
Clinical Trials
Lipids

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Are There Benefits to Specific Antihypertensive Drug Therapy? / Cushman, William.

In: American Journal of Hypertension, Vol. 16, No. 11 II, 01.11.2003.

Research output: Contribution to journalArticle

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