Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Hypertension in adults: summary of updated NICE guidance

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5310 (Published 21 October 2019) Cite this as: BMJ 2019;367:l5310

Rapid Response:

Thiazides much better choice than ACE inhibitors

Since antihypertensive drug treatment should take into account patient preferences, all patients must be informed on high quality, level of evidence I, clinical data.

An updated Cochrane systematic review of randomized clinical trials (RCTs) including 58,040 adult patients with moderate to severe primary hypertension revealed high-quality evidence that first-line low-dose thiazides reduced mortality, total CVS, stroke and coronary heart disease.
Low-to moderate-quality evidence showed that first-line beta-blockers did not reduce mortality or coronary heart disease but reduced stroke and total CVS.
Low-quality evidence showed that first-line calcium channel blockers reduced stroke and total CVS but not coronary heart disease or mortality.
Low-to moderate-quality evidence showed that first-line ACE inhibitors reduced mortality, stroke, coronary heart disease and total CVS, but on mostly secondary prevention population.
Reference
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001841.pub3/...

Another updated Cochrane systematic review of randomized clinical trials (RCTs) concluded that first-line renin angiotensin system inhibitors caused more heart failure and stroke than first-line thiazides.
Reference
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008170.pub3/...

Competing interests: No competing interests

22 October 2019
Stavros Saripanidis
Consultant in Obstetrics and Gynaecology
Thessaloniki, Greece