Some thoughts about recent hypertension trials

Abstract

Beta-blockers plus thiazide-based therapy fails to reduce nonfatal stroke and is associated with more new diabetes compared to newer agents. Diabetes doubles the risk for cardiovascular adverse outcomes. Reduction of adverse outcomes and regression of coronary artery disease is associated with systolic blood pressure reduction using combined calcium antagonists and angiotensin II active agents vs. beta-blockers plus thiazide. There is increasing evidence to support the following strategy: • Optimal systolic blood pressure greater than 120 mmHg but less than 130 mm Hg in coronary artery disease patients when LDL and other prevention measures are deployed • Combinations of drugs with differing modes of action; for example, ACE inhibitors and calcium antagonists • In patients with risk factors for diabetes avoid beta-blockers and thiazides I conclude from this information that newer strategies; that is, calcium antagonists and ACE inhibitors/ARBs vs. traditional strategies of diuretics and beta-blockers, newer therapy results in substantial reduction in new onset diabetes mellitus and nonfatal stroke, but there is no difference in death or nonfatal myocardial infarction. © 2007 Wiley Periodicals, Inc.