Review on comparative efficacy of antihypertensive medication for prevention of cardiovascular outcomes

Abstract

One of the main components of managing a patient with hypertension is deciding which drug to prescribe for first-line therapy. This decision should be made primarily on the basis of the best available evidence of the drug’s ability to prevent adverse health outcomes of the diseases. The objective of this review is to determine the relative effects of different antihypertensive drugs in reducing the incidence of cardiovascular outcomes. Articles included in this review were randomized controlled trials and metaanalysis of RCTs. Relevant articles were obtained from Google scholar database, manual Google search and reference lists of retrieved article. Titles and abstracts were assessed for relevance and those potentially fulfilling the inclusion criteria were then assessed in full text. The following main outcomes were selected: Stroke, myocardial infarction, Coronary heart disease, heart failure, cardiovascular mortality and cardiovascular morbidity. The evidence in this review shows the newer antihypertensive drugs (CCBs and ACEIs) are better than conventional antihypertensive drugs in preventing stroke. The risk of myocardial infarction can be better reduced by using newer antihypertensive drugs like ARBs and ACEIs. All of the antihypertensive drugs did not have a significant difference in prevention of cardiovascular mortality. In hypertensive patients who had also diabetics the newer drugs have equal effectiveness with the conventional once to reduce cardiovascular mortality. The risk of myocardial infarction in this type of patients is better reduced by using ACEIs than conventional antihypertensive drugs and CCBs. CCBs are better than ACEIs to reduce the risk of stroke. ARB drugs are better for diabetic hypertensive patients to prevent cardiovascular mortality and morbidity.