Should -blockers and diuretics remain as first line therapy for hypertension? Thiazide-Type Diuretics and -Adrenergic Blockers as First-Line Drug Treatments for Hypertension

Systemic arterial hypertension affects 72 million US adultsand an additional hundreds of millions of persons world-wide.1,2 Most of these are candidates for pharmacological treatment to reduce risk of cardiovascular disease (CVD) events, based primarily on a very large body of epidemiolog-ical and intervention research in humans. Because of this high prevalence and the cardiovascular consequences of untreated or inadequately treated hypertension, the selection of drugs for initial and continuing, long-term treatment has large public health and economic implications. Fortunately, such decisions and the expert recommendations that seek to guide them can call on evidence from 4 decades of randomized multicenter clinical trials evaluating effects of treatment on clinical CVD. We summarize that evidence in this article, in approximate chronological order, and we comment on the related treatment guidelines. We close with some of the majo