Comparing Antihypertensive Medications’ Effects on Blood Pressure

Clinical Takeaway

: A systematic review and meta-analysis shows that standard-dose dual therapy lowers systolic blood pressure more than monotherapy at twice the standard dose.

Context

We have limited information on the comparative blood pressure (BP)–lowering efficacy of antihypertensive drug classes. Investigators pooled data from randomized, double-blind, placebo-controlled trials involving more than 100,000 patients with hypertension (mean systolic/diastolic BP, 154/100 mm Hg) who received angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), β-blockers (BBs), or diuretics.

Key Results

Standard-dose monotherapy reduced placebo-corrected systolic BP by ≈9 mm Hg from baseline; doubling the dose yielded an additional 1.5-mm Hg reduction.
The different classes, at the standard dose, reduced systolic BP as follows:
- ACE inhibitors, 7 mm Hg
- ARBs and BBs, 9 mm…

Reviewing Author

Jennifer L. Cluett, MD

Disclosures

Grant/Research SupportAmerican Heart Association; NIH/National Heart, Lung, and Blood Institute; NIH/National Institute on Minority Health and Health Disparities

Editorial BoardsHypertension

Leadership Positions in Professional SocietiesAmerican Heart Association (President of the Greater Boston Board of Directors)