Episode 8: Taking the Pressure Off: Hypertension Drugs
In our eighth installment, we discuss the initiation of hypertensive drug therapy. In recommending thiazide diuretics, we outline the evidence (e.g. ALLHAT trial) showing equivalence and the significantly lower yearly cost. We debate (politely this time) dosing and attempt to dispel the smokescreen of thiazide metabolic issues (e.g. blood glucose). The usual banter ensues around the challenges of monitoring therapeutic effect and the pseudo-logic of initiating combination drugs.
1) ALLHAT – no difference in CVD outcomes between thiazides, ACEI or CCBs in hypertensive patients treated for 4.9 years
2) Additional benefits of ACEIs/ARBs on renal outcomes in diabetic patients is unproven
3) No evidence of superiority of CCBs or ACEs over thiazides for hypertenison in type 2 diabetics