The hypertension guideline that physicians follow is referred to as
JNC-7 and was made available back in December 2003. As such it's been over 8 years since it was last updated which is eons when it comes to medical literature, especially in the field of cardiovascular medicine, especially hypertension. JNC-7 tells us to use thiazide-type diuretics first-line in patients w/uncomplicated hypertension w/o compelling indications for any other drug class.
I mention this because a
meta-analysis was published early online 2 weeks ago in the European Heart Journal concluding that
angiotensin-converting enzyme (ACE) inhibitors decreased all-cause mortality by 10% compared to other blood pressure lowering agents. The authors analyzed data from 20 randomized controlled trials including mortality data for which 158,998 participants avg 67yo w/58% men were followed for 4+ years. Interestingly, their cousin class, the AT1 receptor blockers (ARBs) had no effect on mortality. Their only benefit? Less likely to cause the dry ticklish cough associated w/ACE inhibitors.
Armed w/this study, I'll have to try harder to convince my patients complaining of a new onset dry ticklish cough coincident with starting an ACE inhibitor that they're better off over the next 4+years to take the medication and learn to tolerate the side effect rather than switching to another blood pressure lowering drug. Plus I'll start considering the use of ACE inhibitors as first line agent in uncomplicated hypertension, even as I wait for JNC-8.
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