高血壓--五大類降血壓藥物都可做為第一線用藥(2022年台灣高血壓指引)

2022年台灣高血壓指引 

目前高血壓的第一線用藥. 所有五大類藥物都可做為第一線用藥. 

8.2 First-line antihypertensive drugs 

Several meta-analyses of large-scale RCTs of antihypertensive drugs have consistently shown that the clinical benefits of antihypertensive drugs are directly proportional to the magnitude of BP reductions, rather than the classes of antihypertensive drugs.232,233,343 

These meta-analyses also demonstrated that five major classes of antihypertensive drugs including ACE inhibitors [A], ARBs [A], -blockers [B], calcium-channel blockers (CCBs) [C], and thiazides diuretics [D] are all effective in preventing the occurrence of CVD (Figure 6). 

There is evidence that -blockers were inferior to the other 4 major classes of drugs for the prevention of major CV diseases, stroke, and renal failure.232,344,345 

Hypertension Guidelines issued by ESC/ESH, ACC/AHA, and International Society of Hypertension all recommend ACE inhibitors, ARBs, CCBs and thiazides diuretics, but not -blockers, as first-line antihypertensive drugs. 

However, most trials involving -blockers are based on the use of atenolol. No RCTs have evaluated the effects of newer-generation -blockers, such as bisoprolol, carvedilol and nebivolol, on all-cause mortality. 

All these newer-generation -blockers have been shown to provide morbidity and mortality benefits in patients with heart failure and reduced ejection fraction. 

In the most recently updated metaanalysis including 66,625 hypertensive patients from 45 RCTs to compare the 5 major antihypertensive drugs, all-cause death is similar for renin-angiotensin system (RAS) inhibitors, CCBs, thiazides and -blockers.346 Chinese population is more sensitive to the effects of - blocker propranolol on heart rate and BP than Caucasian populations.347 

The evidence demonstrating the differential effects of 5 major antihypertensive drugs in Asian populations is lacking.348 

Considering the above lines of evidence, the Task Force recommends that all 5 major antihypertensive drugs (ACE inhibitors [A], ARBs [A], -blockers [B], CCBs [C], and thiazides diuretics [D]) are first-line antihypertensive drugs (COR I, LOE B).