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Hypertension guidelines emphasize achieving blood pressure (BP) targets but do not recommend one first-line antihypertensive class over another, and clinicians have little evidence to guide that choice in older adults. In this observational study in Japan, investigators compared outcomes after initial treatment with an angiotensin-receptor blocker (ARB) and a calcium-channel blocker (CCB) among 30,000 adults aged 75 years or older. They adjusted for baseline differences between groups, including use of other antihypertensive medications.
The estimated 5-year risk of death was significantly lower with ARBs than CCBs (13% vs. 15%) despite a minimal between-group difference (<1 mm Hg) in achieved systolic BP.
ARB use was associ…