Thiazides best first choice for hypertension

High blood pressure or hypertension can increase the risk of heart attacks and stroke. 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.

The Cochrane Hypertension Group updated their original 2009 Cochrane Review looking at what drug class was the best first-line choice in treating adult patients with raised blood pressure. No new trials were found in the update; keeping the total at 24 studies, that randomly assigned 58,040 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.

The Cochrane Review 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 decision as to which drug to use first-line for the management of hypertension is an important one for clinicians" says James Wright the first author of this updated Cochrane Review.  “Knowing that the evidence for first-line thiazides is better than other classes of drugs is great news for clinicians as thiazides are also the least expensive and have other advantages.  Both clinicians and patients can be reassured that Cochrane evidence, recognized as the gold standard of health evidence, supports this."

Updated review: First-line drugs for hypertension