Prescrire international
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Prescrire international · Sep 2014
ReviewTreating essential hypertension. The first choice is usually a thiazide diuretic.
We concluded in 2004 that the first-choice treatment for hypertension in adults was single-agent therapy with the thiazide diuretic chlortalidone or, when this drug is not available, the thiazide diuretic hydrochlorothiazide. As of early 2014, does evidence challenge this choice in adults without diabetes or cardiovascular or renal disease? To answer this question, we reviewed the available evidence, using the standard Prescrire methodology. The current treatment threshold for hypertensive adults without diabetes or cardiovascular or renal disease is blood pressure above 160/100 mmHg or 160/90 mmHg, with some uncertainty over which diastolic threshold should be used. ⋯ As of early 2014, the first-choice treatment for hypertension in nondiabetic adults without cardiovascular or renal disease should be chlortalidone. If chlortalidone is not available, it appears reasonable to choose another thiazide diuretic, hydrochlorothiazide, possibly combined with amiloride or triamterene. When a diuretic cannot be used, it is better to choose an ACE inhibitor: captopril, lisinopril or ramipril.