Inpharma 1389 - 31 May 2003

Low-dose diuretics most effectiveantihypertensive therapy

"Low-dose diuretics are the most effective first-linetreatment for preventing the occurrence ofcardiovascular disease [CVD] morbidity and mortality" inpatients with uncomplicated hypertension, according toresearchers from the US.

They conducted a meta-analysis of 42 randomisedcontrolled trials of antihypertensive therapies (192 478patients) in which major CVD endpoints were evaluatedover ≥ 1 year. The therapies that were assessed includedlow-dose diuretics, β-blockers, calcium channelantagonists, ACE inhibitors, angiotensin receptorantagonists and α-blockers.

Treatment with low-dose diuretics significantlyreduced the risk of coronary heart disease (CHD),congestive heart failure (CHF), stroke, CVD events, CVDmortality and total mortality, relative to placebo. ACEinhibitors also significantly reduced the risk of all ofthese outcomes, relative to placebo, while β-blockers,calcium channel antagonists and angiotensin receptorantagonists significantly reduced the risk of all outcomesexcept CHD.

Compared with β-blocker therapy, low-dose diureticswere associated with a significantly lower incidence ofCVD events (relative risk of 0.89 [95% CI 0.8–0.98]).Furthermore, low-dose diuretics were associated withsignificantly lower rates of CHF, stroke and CVD events,compared with ACE inhibitors (0.88 [0.8–0.96], 0.86[0.77–0.97] and 0.94 [0.89–1], respectively), andsignificantly lower rates of CHF and CVD events,compared with both calcium channel antagonists (0.74[0.67–0.81] and 0.94 [0.89–1], respectively) and α-blockers (0.51 [0.43–0.6] and 0.84 [0.75–0.93],respectively). None of the treatments were significantlysuperior to low-dose diuretics for any of the outcomes.

It should be noted that only three trials evaluatedangiotensin receptor antagonists and only one assessedα-blockers.

The researchers comment that "low-dose diureticsshould serve as the active-treatment control arm offuture superiority or equivalence trials in patients withhypertension".Psaty BM, et al. Health outcomes associated with various antihypertensivetherapies used as first-line agents: a network meta-analysis. JAMA: the Journal ofthe American Medical Association 289: 2534-2544, 21 May 2003 800925963

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Inpharma 31 May 2003 No. 13891173-8324/10/1389-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved