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Review of Wright JM, Musini VM, Gill R. First-line drugs for hypertension (Review). Cochrane Database Syst Rev 2018;4:10.1002/14651858.CD001841.pub3.
Commentary by Dr Elizabeth Adeyeye and Dr Teck Khong, Clinical Pharmacology, St George's, University of London, London, UK
Series Editor Dr Teck Khong, DTB Associate Editor, Clinical Pharmacology, St George's, University of London, London, UK
Key learning points
There is high-quality evidence that morbidity and mortality were reduced with low-dose thiazide diuretics used first line compared with placebo in individuals with hypertension.
First‐line use of ACE inhibitors and calcium channel blockers may be similarly effective but the evidence was less robust.
First-line use of high-dose thiazides or beta-blockers was inferior to first-line low-dose thiazides.
Low-dose thiazide diuretics are effective in reducing morbidity and mortality associated with moderate-to-severe primary hypertension in adults.1
Hypertension remains a leading contributor to the burden of cardiovascular morbidity and mortality. This Cochrane systemic review has updated the original meta-analysis published in 2009 and the authors have assessed the outcomes associated with the main groups of antihypertensive drugs with the aim of establishing which should be used first-line.1 2 It did not include any new or additional studies and has confirmed the conclusions from the original review. The authors evaluated the evidence on morbidity and mortality when six of the …
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