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Review: low dose diuretics are the best first line antihypertensive treatment

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 Q In patients with hypertension, how do low dose diuretics compare with other antihypertensive agents as first line treatment in preventing major cardiovascular disease (CVD) endpoints?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ Internal medicine ★★★★★☆☆ Cardiology ★★★★★★☆


Embedded ImageData sources:

Medline (1995–2002), previous meta-analyses, and journal reviews.

Embedded ImageStudy selection and assessment:

randomised controlled trials (RCTs) evaluating major CVD endpoints in hypertensive patients treated with placebo, diuretics, β blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, or α blockers.

Embedded ImageOutcomes:

coronary heart disease (CHD) (fatal and nonfatal myocardial infarction and CHD death); fatal and nonfatal stroke; fatal and nonfatal congestive heart failure (CHF); CVD events (CHD, stroke, CHF, and other CVD mortality); and total mortality.


Analysis was done using network meta-analysis, which …

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  • Abstract and commentary also appear in ACP Journal Club.

  • For correspondence: Dr B M Psaty, University of Washington, Seattle, WA, USA.

  • Sources of funding: National Heart, Lung and Blood Institute; National Institute on Aging; American Heart Association; AHA Pharmaceutical Roundtable Outcomes Research Program.