A systematic review of commencing full-dose antihypertensives in newly diagnosed hypertension

Background: Hypertension is the UK’s most common treatable cause of mortality and morbidity, including cardiovascular disease (CVD), renal disease and dementia

Objective: This systematic review has explored the efficacy and safety of commencing full-dose antihypertensive treatment in individuals with essential hypertension.

Method: Method16 randomised controlled trials (RCTs) were eligible for inclusion, with some RCTs assessing more than one treatment. The review assessed commonly used antihypertensive drugs (perindopril 8 mg, ramipril 10 mg, amlodipine 10 mg, losartan 100 mg, irbesartan 300 mg, candesartan 16 mg and candesartan 32 mg) compared to low starting doses or placebo RCTs. Eligible studies included 12 RCTs that compared full vs low doses and 19 RCTs that compared full starting doses vs placebo. The primary outcome was the difference in blood pressure reduction compared to controls (reported or calculated).

Results: Using full doses compared to low doses led to better BP reduction (overall, 3.9/2.2 mmHg lower achieved BP) without an increase in adverse effects. This notion is supported by the changes achieved with full-dose treatment initiation compared to placebo (average over all studies: 11.4 [4.4]/6.5 [2.9] mmHg).

Conclusions: This review indicates that initiating full-dose antihypertensives for essential hypertension may be beneficial and safe. The available data are limited, and further RCTs are required to assess this in specific patient groups to assess safety and efficac.