Antihypertensive Class and Cardiovascular Outcomes in Patients With HIV and Hypertension.

[Figure: see text].

Continued importance of diuretics and beta-adrenergic blockers in the management of hypertension.

The use of thiazide diuretics as one of the preferred antihypertensive medications has stood the test of time. Since the introduction of orally effective agents in 1957 to 1958, these drugs have continued to prove their usefulness. Numerous clinical trials have confirmed that these medications are as or more effective in reducing blood pressure and cardiovascular events than any of the other effective antihypertensive agents. Although some metabolic changes may occur with higher dosages of these medications, they seem to be of limited clinical significance. In addition to being well tolerated and effective. thiazide-type diuretics are less expensive than other agents. This should be considered in view of the fact that quality of care is not compromised when the less expensive medication is used. beta-Blockers should also be considered as a major drug class in the management of hypertensive patients. There are few studies directly comparing these drugs with other agents. Although some data suggest that they are less effective in reducing CHD events in the elderly, there are numerous situations where beta-blockers are clearly indicated. Combination therapy with a beta-blocker and diuretic has been shown to be highly effective in reducing cardiovascular events in both diabetic and nondiabetic patients.

Efficacy of different drug classes used to initiate antihypertensive treatment in black subjects: results of a randomized trial in Johannesburg, South Africa.

BACKGROUND: Thiazides are recommended to initiate antihypertensive drug treatment in black subjects. OBJECTIVE: To test the efficacy of this recommendation in a South African black cohort. METHODS: Men and women (N = 409), aged 18 to 70 years, with a mean ambulatory daytime diastolic blood pressure between 90 and 114 mm Hg, were randomized to 13 months of open-label treatment starting with the nifedipine gastrointestinal therapeutic system (30 mg/d, n = 233), sustained-release verapamil hydrochloride (240 mg/d, n = 58), hydrochlorothiazide (12.5 mg/d, n = 58), or enalapril maleate (10 mg/d, n = 60). If the target of reducing daytime diastolic blood pressure below 90 mm Hg was not attained, the first-line drugs were titrated up and after 2 months other medications were added to the regimen. RESULTS: While receiving monotherapy (2 months, n = 366), the patients' systolic and diastolic decreases in daytime blood pressure averaged 22/14 mm Hg for nifedipine, 17/11 mm Hg for verapamil, 12/8 mm Hg for hydrochlorothiazide, and 5/3 mm Hg for enalapril. At 2 months the blood pressure of more patients treated with nifedipine was controlled: 133 (63.3%, P