Beneficial effects on morbidity of different drug groups

Diuretics:

• significantly reduce the risk of stroke, coronary events and all cardiovascular events in 65 - 74 age group (Systolic Hypertension in the Elderly (SHEP) - a long-acting thiazide diuretic reduced the incidence of cardiac events by 34% compared to placebo over a period of 5 years, and this effect was even greater in diabetic patients (twice the effect) (1)
• a thiazide in combination with amiloride has been shown to significantly reduce the risk of stroke and coronary events in younger hypertensives (2)
• a thiazide-like diuretic indapamide has been reported to apparently reduce left ventricular mass more effectively than enalapril (3)

Beta blockers:

• reduce the risk of stroke only in younger non-smokers
• indicated if history of cardiovascular disease

Calcium antagonists:

• reduce blood pressure and recent evidence shows reduction in risk of stroke (SYST-EUR study)
• indicated in isolated systolic hypertension

ACE inhibitors:

• unpleasant side effects are unlikely
• prolong life with co-existing heart failure
• limit progression of micro-albuminuria with co-existing insulin dependent diabetes
• reduces risk of stroke and coronary artery disease in normotensive patients (with diabetes or at high cardiovascular risk)

Reference:

• (1) Gosse P et al (2000). Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5mg versus enalapril 20mg: the LIVE study. J Hypertens, 18, 1465-75.
• (2) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final reslts of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA (1991), 265, 3255-64.
• (3) Medical Research Council trial of hypertension in older adults: principal results. MRC Working Party. BMJ (1992), 304, 405-12
• (4) Bosch J et al. Long-term effects of ramipril on cardiovascular events and on diabetes: results of the HOPE study extension.Circulation. 2005 Aug 30;112(9):1339-4