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

https://doi.org/10.1136/ebm.9.1.12

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    Psaty BM, Lumley T, Furberg CD, et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003;289:2534–44.
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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 ★★★★★★☆

    METHODS:

    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.

    MAIN RESULTS

    Analysis was done using network meta-analysis, which …

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    Footnotes

    • Abstract and commentary also appear in ACP Journal Club.

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

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