Are thiazides justifiable in the management of hypertension?
Therefore, the current recommendation for the use of thiazides in the management of hypertension is justifiable, based on the evidence presented here: start with a low dose (12.5 mg hydrochlorothiazide, or the equivalent), increase the dose if necessary, and do not exceed a dose of 50 mg of hydrochlorothiazide, or the equivalent.
Are low‐dose thiazides more effective than first‐line beta‐blockers and ACE inhibitors?
First‐line low‐dose thiazides were more effective than first‐line high‐dose thiazides and first‐line beta‐blockers. The treatment effect for first‐line ACE inhibitors was similar to low‐dose thiazides but less robust, and ACE inhibitors are more expensive than thiazides.
Are thiazide diuretics safe for African Americans?
Thiazide Diuretics are recommended for first line use for African Americans by JNC 8. They should be used in combination with Calcium Channel Blockers (CCB’s). Some are listed below by generic name:
What are the limitations of first‐line thiazide therapy?
A potential limitation of attributing the benefit predominantly to the first‐line thiazide is the fact that in some of the thiazide trials, the first‐line therapy included the thiazide combined with another drug. In two trials, the first‐line therapy was a combination of a thiazide plus a potassium sparing diuretic (EWPHE 1985; MRC‐O 1992).
Why are ACE-I and ARBS not recommended for African black population?
It is commonly reported that the blood pressure lowering efficacy of renin angiotensin system (RAS) inhibitors is attenuated in African Americans due to a greater likelihood of having a low renin profile. Therefore these agents are often not recommended as initial therapy in African Americans with hypertension.
Why are calcium channel blockers recommended as first-line therapy for African American people with hypertension?
Diuretics or calcium channel blockers are recommended for monotherapy in blacks without CKD. In blacks with CKD and proteinuria, ACE-I should be used early in the treatment regimen because of the incidence of end-stage renal disease in blacks.
Which antihypertensive is best for African American?
The American Society of Hypertension and the International Society of Hypertension recommends a CCB or thiazide diuretic (CCB preferred, but thiazide diuretic if cost is a concern) as initial drugs of choice for black patients. If additional treatment is indicated, they suggest adding an ACE-I or ARB.
Why beta-blockers are no longer recommended as the first-line drug for hypertension in patients?
In summary, beta-blockers are effective in preventing cardiovascular disease but are no longer suitable for routine initial treatment of hypertension because their cardiovascular protection and metabolic effects are worse than those of other antihypertensive drugs.
Why ACE inhibitors are not first line for blacks?
Abstract. Angiotensin converting enzyme (ACE) inhibitors have been avoided as an initial therapeutic option in the treatment of hypertension in African-Americans. A major reason for this has been the widespread perception of clinicians that these agents have poor blood pressure (BP) lowering efficacy in this population ...
Which antihypertensives are considered more effective in white patients than in African American patients?
Diuretics and calcium channel blockers are more effective on average in older black patients than beta blockers or ACE inhibitors. White patients, especially younger individuals, appear to respond somewhat better to beta blockers and ACE inhibitors than to diuretics or calcium channel blockers.
What is the first line antihypertensive for African American?
First-line pharmacologic treatment of hypertension for black patients includes thiazide diuretics or calcium channel blockers.
Which antihypertensive medications are the most effective in treating hypertension in African Americans and older adults?
Practice guidelines have long recommended that Black patients with high blood pressure and no comorbidities be treated initially with a thiazide diuretic or a calcium channel blocker (CCB) instead of an angiotensin converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB).
Which is the preferred drug for the treatment of hypertension in African American patients quizlet?
In this cohort, African Americans were most often treated with diuretics, CCBs, and ACE inhibitors. ACE inhibitors appear to be an effective adjunct to diuretic therapy in African Americans due to both the enhanced blood pressure lowering of that combination, and to the decreased production of angiotensin II.
What is the first line drug of choice for hypertension?
There are three main classes of medication that are usually in the first line of treatment for hypertension: 1. Calcium Channel Blockers (CCB) 2. Angiotensin Converting Enzyme inhibitors (ACE inhibitors or ACE-I) and Angiotensin Receptor Blockers (ARBs) 3. Diuretics.
Is beta-blocker first line treatment for hypertension?
Abstract. National and international guidelines still recommend β-blockers (BBs) as first-line agents in uncomplicated prevention of hypertension. However, it has been shown that BBs reduce blood pressure less than other drugs, specifically with regard to central aortic pressure.
Why is propranolol not used frequently as an antihypertensive?
Propranolol is not recommended for the treatment of high blood pressure by the Eighth Joint National Committee (JNC 8) because a higher rate of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to an angiotensin receptor blocker was noted in one study.
What is the best treatment for black people with hypertension?
The American College of Cardiology and American Heart Association 2017 hypertension guidelines suggest initial therapy of a calcium channel blocker (CCB) or thiazide diuretic for black patients. Further, it states that two drugs are often needed for treatment of hypertension in black patients.
What is the best medication for black patients?
The American Society of Hypertension and the International Society of Hypertension recommends a CCB or thiazide diuretic (CCB preferred, but thiazide diuretic if cost is a concern) as initial drugs of choice for black patients. If additional treatment is indicated, they suggest adding an ACE-I or ARB.
Do black people have hypertension?
Background: Black patients have a higher prevalence of hypertension, treatment resistant hypertension, and poorer blood pressure control. It is known that certain antihypertensive agents work better and have different adverse drug event frequencies in black patient populations, which guides monotherapy. However, various guidelines provide different ...
What is ACE inhibitor?
ACE inhibitors are commonly prescribed to treat hypertension. Angiotensin-converting enzyme (ACE) inhibitor-based treatment regimens may not work as well at improving cardiovascular outcomes in black patients with hypertension compared with white patients, according to study findings published in the Journal of the American College of Cardiology. ...
Can ACE inhibitors lower blood pressure?
Although ACE inhibitors are commonly prescribed to lower blood pressure in patients with hypertension , previous findings from randomized controlled clinical trials suggested that ACE inhibitor-based treatment regimens may not yield the same benefits in black patients.
Can ACE inhibitors cause hypertension in black patients?
Black patients who received ACE inhibitor treatment were no more likely to develop adverse effects than white patients. “The results of this study add to a growing consensus among physicians that treatment of hypertension in blacks should not be initiated with ACE inhibitors,” Dr. Ogedegbe said during a press release.
How does high blood pressure affect the world?
High blood pressure, or hypertension, affects more than one in four adults globally and is a major modifiable risk factor for morbidity and mortality. 1 Internationally, guideline based approaches to pharmacotherapy for hypertension have been adopted to simplify clinical practice and improve blood pressure control. 2 3 4 Although some evidence suggests that the effectiveness of drug treatment for hypertension does not differ across the general population, 5 6 guideline recommendations hinge on the understanding that the effect of these drugs differs among specific subpopulations.
Did patients have to be involved in the research question?
No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for design or implementation of the study. No patients were asked to advise on interpretation or writing up of results.