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The Pharmaceutical Journal
Vol 270 No 7250 p711
24 May 2003

Related websites
JAMA abstract (more)
JNC 7 guidance (more)

Low-dose diuretics still the best antihypertensives

Low-dose diuretics are still the best first-line antihypertensives for preventing cardiovascular disease and deaths, according to a network meta-analysis.

Researchers lead by Dr Bruce Psaty from the University of Washington, Seattle, combined data from 42 clinical trials in a network that allowed them to make comparisons between six active treatments and placebo.

Overall, low-dose diuretics were better than placebo for reducing coronary heart disease, congestive heart failure, stroke, cardiovascular events and total mortality. None of the other first-line treatments — beta-blockers, angiotensin-converting-enzyme inhibitors, calcium channel blockers, alpha-blockers and angiotensin receptor blockers — was significantly better than low-dose diuretics for any outcome.

The authors conclude that clinical practice and treatment guidelines should include low-dose diuretics as the first-line treatment. Any future clinical trials should use diuretics as their standard treatment against which other agents are evaluated (JAMA 2003;289:2534).

American BP guidance Updated guidance on the treatment of high blood pressure has been issued by the American Joint National Committee (JNC 7). The guidance says that thiazide diuretics should be the starting point for treatment. It stresses that patients will need to be motivated to continue with their treatments as this gives the best results (JAMA 2003;289:2560).