Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

First line antihypertensive review

The Cochrane Library has published a review of the available evidence that aimed to quantify the benefits and harms of the major first line antihypertensive drug classes: thiazide diuretics, beta-blockers, calcium channel blockers (CCB), angiotensin converting enzyme (ACE) inhibitors, alpha-blockers, and angiotensin II receptor blockers (ARB).

The review included data from 24 trials with 58,040 participants that were of at least one year duration and compared one of the study drugs with placebo or no treatment. 70% of participants in each study were required to have a blood pressure above 140/90 mmHg at baseline.

The review found that low-dose thiazide diuretics reduced all morbidity and mortality outcomes. ACE inhibitors and CCBs provided similar benefits but the evidence was less robust. No trials were found for ARBs or alpha-blockers.

Action: Thiazide diuretics are, once again, supported by the evidence for first line use in the treatment of hypertension.

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