First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care

Study of 87 440 new users of ACEI/ARB, 67,274 new users of CCB, and 22,040 new users of thiazides followed up for 1 year suggests that the current UK algorithmic approach to first line antihypertensive treatment might not lead to greater reductions in blood pressure.

SPS commentary:

This propensity score matched cohort study excluding people with diabetes found that initiation of CCB or ACEI/ARB was linked to similar reductions in BP in age <55 and ≥55 years , whilst reductions in BP appeared numerically greater for black people initiating CCB vs. ACEI/ARB than BP reductions in non-black people, but confidence intervals overlapped between the two groups.

According to the researchers, these results suggest that the algorithm for choice of pharmacotherapy in UK NICE guidance could be simplified; and moving towards a choice of any of the three major hypertension drug classes with suggested compelling indications for their use would align the UK with international guidance, in particular with regard to age.

British Medical Journal