Systematic review of antihypertensive therapies: does the evidence assist in choosing a first-line drug?
PubMedPublished 13 July 1999
James M Wright, Chang‐Hoon Lee, G K Chambers
Citations144
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Low-dose thiazide therapy can be prescribed as the first-line treatment of hypertension with confidence that the risk of death, coronary artery disease and stroke will be reduced, and was significantly better at reducing systolic blood pressure than the other drug classes.
Keywords
Decision SciencesMedicine
Controlled Clinical TrialsMeta-analysis in clinical trials
39,316 Citations1986Rebecca DerSimonian, Nan M. Laird
This paper examines eight published reviews each reporting results from several related trials in order to evaluate the efficacy of a certain treatment for a specified medical condition and suggests a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
The LancetBlood pressure, stroke, and coronary heart disease
4,511 Citations1990Rory Collins, Richard Peto +12 more
A sufficiently high risk of stroke (perhaps because of age, blood pressure, or, in particular, history of cerebrovascular disease) may be the clearest indication for antihypertensive treatment.
The LancetRandomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension
2,994 Citations1997Jan A. Staessen, Robert Fagard +16 more
Among elderly patients with isolated systolic hypertension, antihypertensive drug treatment starting with nitrendipine reduces the rate of cardiovascular complications and may prevent 29 strokes or 53 major cardiovascular endpoints.
The LancetMorbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension)
1,888 Citations1991Björn Dahlöf, L. Hansson +4 more
It is concluded that antihypertensive treatment in hypertensive men and women aged 70-84 confers highly significant and clinically relevant reductions in cardiovascular morbidity and mortality as well as in total mortality.
The LancetMORTALITY AND MORBIDITY RESULTS FROM THE EUROPEAN WORKING PARTY ON HIGH BLOOD PRESSURE IN THE ELDERLY TRIAL*1, *2
1,490 Citations1985A. Amery
JAMAEffects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg
1,317 Citations1967
Male patients with diastolic blood pressures averaging 115 mm Hg or above represent a high-risk group in which antihypertensive therapy exerts a significant beneficial effect.
New England Journal of MedicineSingle-Drug Therapy for Hypertension in Men -- A Comparison of Six Antihypertensive Agents with Placebo
1,206 Citations1993Barry J. Materson, Domenic J. Reda +10 more
In a randomized, double-blind study at 15 clinics, men with diastolic blood pressures of 95 to 109 mm Hg are assigned to receive placebo or one of six drugs: hydrochlorothiazide, atenolol, captopril, clonidine, captanidine, prazosin, or a sustained-release preparation of diltiazem, and the patients continued to receive therapy for at least one year.
JAMAHealth Outcomes Associated With Various Antihypertensive Therapies Used as First-Line Agents
1,090 Citations2003Bruce M. Psaty, Thomas Lumley +5 more
Low-dose diuretics are the most effective first-line treatment for preventing the occurrence of cardiovascular disease morbidity and mortality and future trials should use low-doseDiuretics as the standard for clinically useful comparisons.
JAMAHealth Outcomes Associated With Antihypertensive Therapies Used as First-Line Agents<subtitle>A Systematic Review and Meta-analysis</subtitle>
873 Citations1997Bruce M. Psaty
Until the results of large long-term clinical trials evaluating the effects of calcium channel blockers and ACE inhibitors on cardiovascular disease incidence are completed, the available scientific evidence provides strong support for the current national guidelines, which recommend diuretics and beta-blockers as firstline agents and low-dose therapy for all antihypertensive agents.
BMJRandomised trial of treatment of hypertension in elderly patients in primary care.
727 Citations1986John Coope, T S Warrender
A randomised trial of the treatment of hypertension in 884 patients aged 60 to 79 years at the onset showed a reduction of 18/11 mm Hg in blood pressure over a mean follow up period of 4.4 years.
The American Journal of MedicineTreatment of mild hypertension: A five year controlled drug trial
654 Citations1980Anders Helgeland
In 1972--1973, 785 symptom-free men, aged 40 to 49 years, without target organ damage, with systolic blood pressures between 150 and 179mm Hg and diastolic blood pressure below 110 mm Hg, were assigned at random to one of two groups for a five-year controlled drug treatment trial to evaluate the effect of therapy on cardiovascular complications.
American Journal of HypertensionRationale and Design for the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
597 Citations1996Barry R. Davis
The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind trial in 40,000 high-risk hypertensive patients, is designed to determine whether the combined incidence of fatal coronary heart disease (CHD) and nonfatal myocardial infarction differs between persons randomized to diuretic treatment and each of three alternative treatments.
Journal of HypertensionBeta-Blockers Versus Diuretics in Hypertensive Men: Main Results from the HAPPHY Trial
467 Citations1987Lars Wilhelmsen, G Berglund +8 more
Antihypertensive treatment based on a beta-blocker or on a thiazide diuretic could not be shown to affect the prevention of hypertensive complications, including CHD, to a different extent.
Journal of HypertensionShanghai trial of nifedipine in the elderly
413 Citations1996Lansheng Gong, Weizhong Zhang +7 more
JAMAPrimary Prevention With Metoprolol in Patients With Hypertension
393 Citations1988John Wikstrand
Total mortality was significantly lower for metoprolol than for thiazide diuretics because of fewer deaths from coronary heart disease and stroke and the benefit demonstrated in patients treated with metoprole seems to have important implications for clinical practice.
New England Journal of MedicineThe Effect of Treatment on Mortality in Mild Hypertension
344 Citations1982Hypertension Detection and Follow-up Program Cooperative Group*
The beneficial effect of stepped-care treatment on persons with diastolic pressures who had no evidence of end-organ damage and were not receiving antihypertensive medication when they entered the study is supported.
The LancetHYPOTENSIVE THERAPY IN STROKE SURVIVORS
260 Citations1970A.Barham Carter
In this series significant improvement occurred in treated hypertensive patients who had survived a stroke if they were aged 65 or below, but not if they was older, and in patients aged over 65 treatment of systolic hypertension was of no benefit, although the diastolic hypertensives improved marginally with treatment.
Circulation ResearchAlterations in canine myocardial excitability during ischemia.
241 Citations1977Victor Elharrar, Peter R. Foster +3 more
It is concluded that a gradient of increasing excitability threshold exists as one moves from normally perfused toward more ischemic tissue, passing through a heterogeneous border zone that manifests some areas which have a decreased excitable threshold and other areasWhich have an increased excitabilityreshold, and that changes in excitability importantly influence the determination of refractory period durations and conduction times.
Annals of Internal MedicineDrug Treatment of Hypertension in the Elderly
235 Citations1994Jorge Insúa, Henry S. Sacks +5 more
Treatment of hypertension in elderly patients produces a significant benefit in total mortality and cardiovascular morbidity and mortality, however, this benefit may be reduced in the oldest age groups.
JAMAHypertension in the Elderly
209 Citations1994Cynthia D. Mulrow
Randomized trials demonstrate that treating healthy older persons with hypertension is highly efficacious, and five-year morbidity and mortality benefits derived from trials are greater for older than younger subjects.
American Journal of HypertensionDepartment of veterans affairs single-drug therapy of hypertension studyRevised figures and new data
206 Citations1995Barry J. Materson, D REDA +1 more
It is concluded that single-drug antihypertensive therapy is effective in a majority of stage 1 to 2 diastolic hypertensive patients, although there are important age-by-race differences in success rates among various drug classes.
Journal of HypertensionA meta-analysis of outcome trials in elderly hypertensives
206 Citations1992Lutgarde Thijs, Robert Fagard +4 more
Clinical and Experimental HypertensionThe Effects of Blood Pressure Reduction in Older Patients: An Overview of Five Randomized Controlled Trials in Elderly Hypertensives
185 Citations1993S Mac Mahon, Anthony Rodgers
The results suggest that over 10 years, treatment would prevent at least one major vascular event among every 10 elderly patients at similar risk to those enrolled in the trials.
PubMedLong-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men.
182 Citations1991Timo Strandberg, Veikko Salomaa +4 more
BMJRandomised, double blind, multicentre comparison of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in antihypertensive treatment: results of the HANE study
169 Citations1997Thomas Philipp, Manfred Anlauf +4 more
The LancetBETA-BLOCKERS OR DIURETICS IN HYPERTENSION? A SIX YEAR FOLLOW-UP OF BLOOD PRESSURE AND METABOLIC SIDE EFFECTS
167 Citations1981G Berglund
The results indicate that the frequency of metabolic side effects during diuretic treatment of mild to moderately severe essential hypertension is low and has been grossly exaggerated.
Journal of Chronic DiseasesEffects of treatment in hypertension results of a controlled study
152 Citations1966Frederick Wolff, Robert D. Lindeman
Evidence of the need for continuous close supervision, and the provision of organized teams devoted to the care, of a predominantly Negro clinic population with mild to moderately severe hypertension over a 2-year period is provided.
StrokeMorbidity and mortality in the Systolic Hypertension in the Elderly Program (SHEP) pilot study.
130 Citations1989H. Mitchell Perry, W.M. Smith +8 more
Differences between groups were significant for systolic and diastolic blood pressure but not for death or stroke rates, and a full-scale study has begun to determine the effects of drug therapy for isolated syStolic hypertension on stroke and mortality rates.
HypertensionMetoprolol versus thiazide diuretics in hypertension. Morbidity results from the MAPHY Study.
127 Citations1991John Wikstrand, Ingrid Warnold +8 more
Investigating whether metoprolol given as initial treatment would lower the risk for coronary events more effectively than thiazide diuretics more effectively suggested that different /3-blockers may have different efficacy in preventing coronary events.
Journal of HypertensionClinical results of the Verapamil in Hypertension and Atherosclerosis Study
121 Citations1997Enrico Agabiti Rosei, C. Dal Palú +3 more
After 2 years the systolic and diastolic blood pressures were reduced significantly in members of both treatment groups and the occurrence of cardiovascular events was similar for both treatments.
PubMedNew meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit.
111 Citations1996François Gueyffier, A Froment +1 more
The most constant treatment benefit concerned stroke, although the absolute reduction was very modest in younger patients with mild-to-moderate hypertension, and a trend towards greater absolute benefit under treatment was indicated.
PubMedFinal outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS). A randomized controlled trial.
110 Citations1996N O Borhani, Michele Mercuri +9 more
Annals of the New York Academy of SciencesEVALUATION OF DRUG TREATMENT IN MILD HYPERTENSION: VA‐NHLBI FEASIBILITY TRIAL*
92 Citations1978Hartmud Neurath, Anne I. Goldman +6 more
A feasibility trial to investigate the practicality of determining the advantages and disadvantages of prompt pharmacologic treatment for mild hypertension demonstrated that the required relatively young asymptomatic population could be enrolled in the study and that it could be persuaded to adhere to the protocol for 2 years, but it was evident that intensive efforts would be required in both areas.
BMJBlood pressure reduction in elderly: a randomised controlled trial of methyldopa.
91 Citations1981Margaret Sprackling, J.R.A. Mitchell +2 more
JAMAPrimary Prevention With Metoprolol in Patients With Hypertension
90 Citations1988Jan A. Staessen
The investigators employed the Gehan-Wilcoxon nonparametric test for survival analysis and found in male hypertensive patients with diastolic blood pressures that total and cardiovascular mortality were reduced by metoprolol therapy compared with treatment with a thiazide diuretic.
Japanese Heart JournalProspective study on the treatment of mild hypertension in the aged.
88 Citations1981Kizuku Kuramoto, Satoru Matsushita +2 more
It is suggested that antihypertensive treatment was effective in the aged with mild hypertension, and that careful follow up was needed not only for cardiovascular complications but also for general health condition.
The Medical Journal of AustraliaFAILURE OF THERAPY TO IMPROVE PROGNOSIS IN ELDERLY MALES WITH HYPERTENSION
86 Citations1980Trefor Morgan, Wright R. Adams +2 more
Therapy did not produce an improvement in the lifespan of elderly males with hypertension, and the patients who were treated with thiazide diuretic regimen had a higher mortality rate which was due to a greater number of fatal myocardial infarcts and sudden deaths.
Japanese Heart JournalEffect of Two Different Therapeutic Approaches on Total and Cardiovascular Mortality in a Cardiovascular Study in the Elderly (CASTEL).
80 Citations1994Edoardo Casiglia, Paolo Spolaore +7 more
Overall and cardiovascular annual cumulative mortality were significantly lower in the >> special therapy >> than in the > group, and the fixed combination of atenolol and chlorthalidone reduced mortality below that of the normotensives, independent of other cardiovascular risk factors.
Acta Medica ScandinavicaLow‐dose Antihypertensive Treatment with a Thiazide Diuretic Is Not Diabetogenic
75 Citations1986Göran Berglund, Ove Andersson +1 more
The finding in this long-term trial indicate that in middle-aged men with mild to moderate hypertension a low-dose thiazide diuretic like bendroflumethiazide is as effective and safe an antihypertensive agent as the beta-blocker propranolol is and that it does not induce diabetes.
Hypertension ResearchA 12-Month Comparison of ACE Inhibitor and Ca Antagonist Therapy in Mild to Moderate Essential Hypertension. The GLANT Study.
66 Citations1995Hiroaki Matsuoka
It is suggested that blood pressure reduction per se did not necessarily lead to a parallel decrease in cerebrovascular and cardiovascular complications, as well as drug-related side effects, in patients treated with an ACE inhibitor or Ca antagonist for 12 months.
Archives of Internal MedicineResponse to a second single antihypertensive agent used as monotherapy for hypertension after failure of the initial drug. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents
56 Citations1995Barry J. Materson
HypertensionEffect of stepped care treatment on the incidence of myocardial infarction and angina pectoris. 5-Year findings of the hypertension detection and follow-up program.
55 Citations1984
In individuals with negative findings at baseline, the 5-year incidence of MI and angina pectoris by these indices was less in the Stepped Care than Referred Care cohort, compatible with the conclusion that antihypertensive therapy reduces the incidence of symptomatic CHD.
DrugsOslo Hypertension Study
53 Citations1986Paul Leren, Anders Helgeland
Possible reasons for the failing effect of drug treatment of hypertension on coronary heart disease is discussed, and attention is drawn to the adverse effect of diuretics and β-adrenergic blockers, both on lipid and carbohydrate metabolism.
Blood PressureThe Swedish Trial in Old Patients with Hypertension-2 (STOP-Hypertension-2): A Progress Report
40 Citations1996Lars Lindholm, Lennart Hansson +6 more
In STOP-Hypertension-2, 6628 elderly hypertensive have been randomized to three different treatment regimes: beta-blocker+diuretics, ACE inhibitors, or calcium antagonists, and end-points have occurred at the expected rate.
PubMedThe CASTEL project (CArdiovascular STudy in the ELderly): protocol, study design, and preliminary results of the initial survey.
38 Citations1991Edoardo Casiglia, Paolo Spolaore +8 more
The CASTEL has been performed in order to evaluate the prevalence of hypertension of people aged 65 years or more, to evaluation the cardiovascular risk of elderly subjects from a general population, to verify the feasibility and effectiveness of a systematic continuous community-based hypertension control program in the elderly, and to evaluate whether a population-based therapeutic intervention was able to extend to a great number of elderly hypertensive patients the benefits of a better control of hypertension.
JAMAMAPHY and the Two Arms of HAPPHY
19 Citations1989Ingar Holme
The Steering Committee of the HAPPHY trial should publish the results in JAMA and the meta-analysis presented by Staessen et al cannot be used for comparison of the MAPHY Study with previous trials.
