Which type of medication to use initially for hypertension has been the subject of several large studies and resulting national guidelines.The fundamental goal of treatment should be the prevention of the important "endpoints" of hypertension such as heart attack, stroke and heart failure. Several classes of medications are effective in reducing blood pressure. However, these classes differ in side effect profiles, ability to prevent endpoints, and cost. The choice of more expensive agents, where cheaper ones would be equally effective, may have negative impacts on national healthcare budgets.
In the United States, the JNC7 (The Seventh Report of the Joint National Committee on Prevention of Detection, Evaluation and Treatment of High Blood Pressure) recommends starting with a thiazide diuretic if single therapy is being initiated and another medication is not indicated. This is based on a slightly better outcome for chlortalidone in the ALLHAT study versus other anti-hypertensives and because thiazide diuretics are relatively cheap. A subsequent smaller study (ANBP2) published after the JNC7 did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older male patients.
Despite thiazides being cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry.
In the United Kingdom, the June 2006 "Hypertension: management of hypertension in adults in primary care guideline of the National Institute for Health and Clinical Excellence, downgraded the role of beta-blockers due to their risk of provoking type 2 diabetes.
Diuretics help the kidneys eliminate excess salt and water from the body's tissues and blood.
Only the thiazide and thiazide-like diuretics have good evidence of beneficial effects on important endpoints of hypertension, and hence, should usually be the 1st choice when selecting a diuretic to treat hypertension. The reason why thiazides-type diuretics are better than the others is (at least in part) thought to be because of their vasodilating properties.
Although the diuretic effect of thiazides may be apparent shortly after administration, it takes longer (weeks of treatment) for the full anti-hypertensive effect to develop.
Although beta blockers lower blood pressure, they do not have as positive a benefit on endpoints as some other antihypertensives. In particular, atenolol seems to be less useful in hypertension than several other agents. However, beta blockers have an important role in the prevention of heart attack in people who have already had a heart attack.
Despite lowering blood pressure, alpha blockers have significantly poorer endpoint outcomes than other antihypertensives, and are no longer recommended as a first-line choice in the treatment of hypertension. However, they may be useful for some men with symptoms of prostate disease.
Adverse effects of this class of drugs include sedation, drying of the nasal mucosa and rebound hypertension.
Some adrenergic neuron blockers are used for the most resistant forms of hypertension:
Antihypertensive medication prescription patterns and time trends for newly-diagnosed uncomplicated hypertension patients in Taiwan.(Research article)
Jun 18, 2008; Authors: Pang-Hsiang Liu [1,2]; Jung-Der Wang (corresponding author) [1,2,3] Background Hypertension, a leading contributor to...