THERAPY Diuretics and ~-blockers 'safe' and effective in hypertension

Diuretics and f3-blockers are 'safe', effective and inexpensive in the treatment of hypertension, conclude researchers in the US.

Their finding supports the guidelines of the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure (JNC-V) published in J 993 that recommend the first-line use of low-dose diuretics and l3-blockers in hypertension.

The researchers identified 18 trials involving 48 220 patients that examined the effect of antihyper­tensive therapy on the occurrence of MI and stroke. To identify eligible trials they used a Medline search of the medical literature published between 1980 and 1995 and previously published meta-analyses.

Reductions in stroke, CHD and CHF Their review demonstrated that low-dose diuretic

therapy is associated with 'important reductions' in the incidence of stroke, coronary heart disease (CHD), congestive heart failure (CHF) and total mortality. I3-Blockers were also shown to reduce the incidence of CHF and stroke. However, neither f3-blocker nor high-dose diuretic therapy were shown to significantly reduce the incidence of CHD.

The researchers note that there is little information from large, long-term randomised trials concerning the use of calcium antagonists or ACE inhibitors in the treatment of hyperterision. However, they do acknowledge that in certain patients with hyper­tension, these agents appear to be of benefit. For example, ACE inhibitors are of benefit in patients with CHF, and nondihydropyridine calcium antagonists are of benefit in patients with CHD. Psaty BM. Smith NL, Siscovick DS, Koepsell m, Weiss NS, et al. Health outcomes associated with antihypertensive therapies used as first·line agents: a systematic review and meta-analysis. Journal of the American Medical Association 277: 739-745, 5 Mar 1997 8000181>2

1173-8324197/1078-000111$01.00° Adlslntematlonal Limited 1997. All rights reserved

11

Inpharma·15 Mar 1997 No. 1078