Why the most popular first-line antihypertensive might not be the best

Data on nearly five million patients suggests older drugs are more effective
heart drugs

Patients with hypertension prescribed diuretics rather than ACE inhibitors first-line have a lower risk of myocardial infarction, stroke and hospitalisation for heart failure, a landmark review has found.

The analysis of data from 4.9 million people initiated on antihypertensive monotherapy also showed that non-dihydropyridine calcium channel blockers were significantly inferior to all other classes of blood pressure drugs.

In the systematic review, researchers drew upon real-world evidence of comparative effectiveness and safety from four countries to estimate the risk of 55 health outcomes.

Almost half of the cohort (48%) was initiated on an ACE inhibitor, 17% a thiazide or thiazide-like diuretic, 16% a dihydropyridine calcium channel blocker, 15% an angiotensin receptor blocker, and the remainder a non-dihydropyridine calcium channel blocker.