The choice of drugs should be made according to this evidence. Circulation ; Ernst MH, Moser M. Use of Diuretics in Patients with Hypertension. N Engl J Med ; 3. Robinson DM, Wellington K. Indapamide Sustained Release. A review of its use in the treatment of hypertension. Drugs ; 4. Regression of LV hypertrophy in hypertensive patients treated with indapamide SR 1. J Hypertens ; Am J Hypertens ; 6. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: The Nestor Study.
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Hypertension ; A comparison of outcomes with angiotensin-converting enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med ; Frohlich ED. Treating Hypertension — What are we to believe?. Health outcomes associated with various antihypertensive Therapies used as first-line agents. A network meta-analysis. Incident Diabetes in clinical trials of antihypertensive drugs: a network meta-analysis.
Lancet ; Thiazide Diuretics, Potassium and the development of Diabetes. A quantitative review. Thiazide-induced Dysglycemia. Hypertension ; N Engl J Med ; Chobanian AV. Does it matter how hypertension is controlled? Effects of an angiotensin-converting-enzime inhibitor, Ramipril , on cardiovascular events in high-risk patients.
Fuchs FD. Diuretics : still essential drugs for the management of hypertension. Expert Rev Cardiovasc Ther ; Cushman WC. Ten years follow-up. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of randomized trials in the context of expectations from prospectiveepidemiological studies.
BMJ ; Kaplan NM. The choice of thiazide Diuretics. Why Chlorthalidone may replace Hydrochlorothiazide. Our mission: To reduce the burden of cardiovascular disease. Help centre. All rights reserved. Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more. One of the most important decisions in treating people with elevated blood pressure is what drug class to use first.
This decision has important consequences in terms of health outcomes and cost. We found no new trials in this updated search. In the original review, we found 24 studies that randomly assigned 58, adult people mean age 62 years with high blood pressure, to four different drug classes or placebo. Duration of these studies ranged from three to five years. Drug classes studied included thiazide diuretics, beta-blockers, ACE inhibitors, and calcium channel blockers.
We concluded that most of the evidence demonstrated that first-line low-dose thiazides reduced mortality, stroke, and heart attack. No other drug class improved health outcomes better than low-dose thiazides.
Beta-blockers and high-dose thiazides were inferior. High-quality evidence supported that low-dose thiazides should be used first for most patients with elevated blood pressure. Fortunately, thiazides are also very inexpensive. The evidence for first-line low dose thiazides was high quality. For the other classes, we judged the evidence to be moderate or low quality. First-line low-dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension.
First-line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality. First-line high-dose thiazides and first-line beta-blockers were inferior to first-line low-dose thiazides. This is the first update of a review published in Diabetes management: How lifestyle, daily routine affect blood sugar Diabetes: Eating out Diabetes nutrition: Sweets Diabetes symptoms Diabetes treatment: Can cinnamon lower blood sugar?
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