Comparison of antihypertensive classes

All classes of antihypertensive drugs are equivalent in preventing CHD and stroke according to a British study. In the largest meta-analysis of randomized trials of blood pressure reduction to date, researchers reviewed the efficacy of the 5 major classes of blood pressure medications (thiazides, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium-channel blockers). Beta-blockers were found to have a special effect over and above that of blood pressure reduction in preventing recurrent CHD events in people with a history of CHD (29% risk reduction vs 15% with other drugs), although this affect was limited to a few years after myocardial infarction. Otherwise, the 5 main classes and blood pressure-lowering drugs were similarly effective in preventing CHD events and strokes, with the exception of calcium-channel blockers, which have a slightly higher benefit in preventing stroke (relative risk, 0.92; 95% confidence interval, 0.85-0.98). There was benefit in reducing risk of CHD and stroke with BP-lowering treatment regardless of the patient's pretreatment blood pressure, surprisingly even as low as 110 mmHg systolic and 70 mmHg diastolic. Treatment with blood pressure-lowering medications was also associated with a 13% reduction in all-cause mortality, although there was no reduction in cancer or nonvascular related deaths. The authors conclude that blood pressure lowering is important in everyone over a certain age regardless of pretreatment blood pressure and that all classes of blood pressure medications had similar effective in reducing CHD events and stroke (BMJ 2009;338:b1665).