Key result
First-line ARBs and ACE inhibitors beat CCBs, beta-blockers, and diuretics in two-year persistence, reaching ~69%.
Why the study?
Does the choice of first-line antihypertensive treatment affect persistence and blood pressure control in hypertensive patients?
RCT (n=347)
Randomized
Does the choice of first-line antihypertensive treatment affect persistence and blood pressure control in hypertensive patients?
ARBs and ACE inhibitors as first-line antihypertensive treatments are associated with higher long-term persistence and better blood pressure control compared to beta-blockers and diuretics.
ARBs or ACEIs should be prioritized first-line to maximize persistence; strengthens RCT evidence favoring these agents over CCBs, beta-blockers, and diuretics.
We enrolled 347 hypertensive patients, randomly allocated them to different first-line treatments, and followed-up for 24 months. Persistence on treatment was significantly higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs. CCBs (51.6%), beta-blockers (44.8%), and diuretics (34.4%). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a greater persistence in therapy as compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs. other CCBs (59.3% vs. 46.6%). Systolic and diastolic BP decreased more in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) when compared to beta-blockers (-4.0/-2.3 mmHg) and diuretics (-2.3/-2.1 mmHg).
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Prandin et al. (2007) conducted an RCT in Hypertension (n=347). First-line antihypertensive treatments (ARBs, ACE inhibitors, CCBs, beta-blockers, diuretics) vs. Active comparators (other antihypertensive classes) was evaluated on Persistence on treatment. First-line treatment with ARBs (68.5%) and ACE inhibitors (64.5%) yielded significantly higher 24-month persistence than CCBs (51.6%), beta-blockers (44.8%), and diuretics (34.4%).
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