Which Drug is Best to Lower Blood Pressure?

Which anti-hypertensive drug is best?  In other words, which drug is best at preventing hypertension-related outcomes, such as heart attacks, strokes, and death, while minimizing adverse drug effects?  All five major drug classes are pretty good, according to a recent article in the British Medical Journal.

Contrary to popular belief, physicians do not choose drugs based on the recommendation of the cute drug rep ("pharmaceutical representative") who brought lunch and free pens to the office last week.

U.K. researchers re-examined 147 separate studies that looked at blood pressure-lowering drugs mostly in people who had high blood blood pressure, but also in people using the drugs for other reasons.  The drug trials involved 464,000 patients.

The five major classes of anti-hypertensive drugs are:

• thiazides (example: hydrochlorothiazide)
• angiotensin-converting-enzyme (ACE) inhibitors (example: lisinopril)
• beta-blockers (example: metoprolol)
• calcium-channel blockers (example: amlodipine)
• angiotensin-receptor blockers (example: losartan)

Compared with placebo or no treatment, these drugs were associated with 13% lower risk of death from any cause.  They drugs reduced stroke rates by 41%, and heart attacks and sudden cardiac death by 22%.  With the exception of a few beta-blockers (called "non-cardioselective"), they all lessened the risk of heart failure. 

Two classes of drugs dominated the others in two situations:

1. For people with a heart attack in the last two years, beta-blocker users had better outcomes.
2. Calcium-channel blockers were better than the others at preventing strokes, although all drugs were better than placebo or no treatment.

Talk to your personal physician about a beta-blocker if you've had a heart attack in the last two years.  Most heart attack patients are sent home from the hospital on one.  If you've have high blood pressure and a stroke, or a strong family history of strokes, ask your physician about calcium-channel blockers. 

And don't forget non-pharmaceutical ways to control blood pressure, such as regular exercise, weight management, and salt restriction.

-Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

References:  Law, M.R., et al.  Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies.  British Medical Journal, 338 (2009): b1665.