Class-effect with antihypertensive medications: Pharmacologic considerations

Abstract

Class effect is easy to conceptualize when the change in blood pressure (BP) as a primary end point has been determined and dose equivalence has been established. Class effect is an indistinct term if non-BP end points are being assessed and unconventional dosing, either dose amount or dose frequency, occurs. With different classes of drugs, such as diuretics, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers, determining dose equivalence from outcomes trials is confused by varying differences in dosing frequencies and titration requirements. If 3 or more drugs in a class show clinical effects as a result of large outcome studies, the Food and Drug Administration may consider this as being evidence for a class effect; however, labeling issues would have to be resolved. Therefore, if a compound is being proposed for therapeutic substitution within a class, clinicians should have familiarity with the compound before administering/prescribing it. J Clin Hypertens (Greenwich). © 2009 Wiley Periodicals, Inc.