Choosing a First-Line Drug for Older Adults with Hypertension: An Evidence-Based Approach

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

James M. Wright, MD, PhD, CRCP(C), Professor, Departments of Anesthesiology, Pharmacology & Therapeutics and Medicine, University of BC, Coordinating Editor, Cochrane Hypertension Review Group, Vancouver, BC.

Choosing the optimal first-line drug for patients with hypertension must address a hierarchy of treatment goals: reduction in mortality and morbidity, efficacy in lowering blood pressure, ensuring tolerability, and minimizing cost. This article examines the evidence for the different classes of first-line antihypertensive drugs in light of these four goals. The evidence indicates that first-line low-dose thiazides are better than or equivalent to other antihypertensive drug classes for each of the goals of therapy in both people with hypertension in general and in older adults ≥ 60 years of age.
Keywords: hypertension, thiazide, first-line, older adults, evidence-based.


do agree with the study . as per my own practice

Low dose diuretic will not control BP satisfacory multimedication low dose is in most cases needed. Hom BP monitoring will give best information.

I have a hard time with this. I have had it drilled into my head about the cardiac and nephro protection of ACE-I. I routinely use ACE/hct combinations.