[Which antihypertensive drugs should be used in the primary prevention of cardiovascular disease?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypertension are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the second of three articles describing these guidelines.
MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These were revised through discussions with a panel of physicians, and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations. RESULTS AND
INTERPRETATION: Thiazides should be first-choice drugs for the treatment of uncomplicated hypertension. Beta-blockers are a reasonable second choice. The treatment goal should be below 140/90 mm Hg. For combination therapy, thiazides and beta-blockers should be first choice. Diabetic patients should be treated aggressively with a diastolic blood pressure goal below 80 mm Hg. Angiotensin-II antagonists or angiotensin converting enzyme-inhibitors should be first choice drugs for diabetics with microalbuminuria. Patients with hypercholesterolaemia are not given a particular recommendation for choice of drug. Patients with asthma or chronic obstructive pulmonary disease should choose other drugs than beta-blockers. Thiazides should be avoided if the patient has, or has had, gout.