Thiazide-Type Diuretics and β-Adrenergic Blockers as
First-Line Drug Treatments for Hypertension
by Jeffrey A. Cutler, and Barry R. Davis
Circulation
Volume 117(20):2691-2705
May 20, 2008
Copyright © American Heart Association, Inc. All rights reserved.
Figure 1. Percentage of drug mentions by class of antihypertensive agent, 1982–1993.21 Data
from IMS America.59 Reprinted from Manolio et al,21 with permission.
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.
Figure 2. Mean systolic and diastolic BP by year during follow-up.25 Reprinted from Reference
25, with permission.
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.
Figure 3. Incident hospitalized (Hosp) heart failure (HF) outcomes by antihypertensive treatment
group (amlodipine/lisinopril vs chlorthalidone).40 *Prespecified end point of treated,
hospitalized, or fatal heart failure.
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.
Figure 4. Cumulative event rates for hospitalized (Hosp)/fatal heart failure (HF) by treatment
group.39.
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.
Figure 5. Cox regression models showing the hazard ratios (95% CIs) associated with IDM
during the first 2 years of follow-up on subsequent CVD and renal end points in those without
DM at baseline.44 All hazard ratios controlled for treatment group (total cohort), 2-year blood
pressure, age, race, sex, smoking status, baseline fasting glucose level, baseline body mass
index, 2-year serum potassium level, and atenolol and statin administration at 2 years.
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.
Figure 6. Network meta-analysis of first-line treatment strategies in randomized controlled
clinical trials in hypertension.48 Asterisks, placed after the closed parentheses of the 95% CI,
indicate that β-blockers (P<0.05), angiotensin-converting enzyme inhibitors (P<0.05), calcium
channel blockers (P<0.05), and angiotensin receptor blockers (P<0.05) were significantly better
than placebo for outcome. α-Blockers were not significantly better than placebo for any outcome
(P>0.05).
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.
Figure 7. JNC7 algorithm for treatment of hypertension.49 SBP indicates systolic BP; DBP,
diastolic BP; ACEI, ACE inhibitors; ARB, angiotensin receptor blockers; and BB, β-blockers.
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.
Figure 8. Outcome data for all β-blockers vs other antihypertensive treatment.53 CONVINCE
indicates Controlled Onset Verapamil Investigation of Cardiovascular End Points; ELSA,
European Lacidipine Study on Atherosclerosis; HAPPHY, Heart Attack Primary Prevention in
Hypertension; INVEST, International Verapamil-Trandolapril Study; MRC, Medical Research
Council; NORDIL, Nordic Diltiazem Study; STOP-2, Swedish Trial in Old Patients With
Hypertension; and UKPDS, UK Prospective Diabetes Study.
Jeffrey A. Cutler, and Barry R. Davis Circulation.
2008;117:2691-2705
Copyright © American Heart Association, Inc. All rights reserved.