Beta blockers and diuretics are not the best choices for hypertension

Adapted from Medscape 2 Sept 2022. Hypertension: Real world efficacy of beta blockers versus other anti-hypertensives by Vinod Rane BS Pharm

Patients with hypertension who were treated with ACE inhibitors, Sartans and Calcium Channel blockers such as Amlodipine and Lercanipide had a lower risk of all- cause mortality than those treated with beta blockers.

The risk of all- cause mortality was no different between beta blocker users and those using diuretics.

Cardiovascular mortality was lowest in those treated with ACE inhibitors compared to beta blockers, Sartans, calcium channel blockers and diuretics.

Adapted from Sue Hughes Medscape August 26 2022 TIME: Cardiovascular events similar with evening or morning dose of blood pressure medications.

A five year trial looking at outcomes in those who took their blood pressure medications at night or in the morning showed no difference.

Previous studies have concluded that there could be a benefit to taking anti-hypertensives at night. Dundee researchers headed by Professor Tom MacDonald looked at hard outcomes which included vascular deaths, and non-fatal heart attacks and strokes.

They found “not a smidge of difference” between the two groups.

The study also showed that falls, fractures, or dizzy spells were no more common between the groups. The main thing he said was to take the medications every day at the same time and pick the time that suits you best.

The group tested had an average age of 65, 14% had diabetes,4% smoked,13% had prior CVD and the mean blood pressure at entry was 135/79. The patients were recruited from both primary and secondary care. The duration of follow up was between 5 and 9 years.

My comments: I am aware of the controversies regarding day and night time anti-hypertensives. Some doctors think that blood pressure control is better if drugs are taken at night and some think compliance is better if they are taken in the morning. I take my medication twice a day by splitting the dosage. That way I get good 24 hour coverage and if I forget a dose there is another one coming along in 12 hours or so.