Thread by @Drug_Evidence

THREAD: Primary #hypertension therapy: after thiazides, an ACEI or an ARB?

1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021

Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices: ti.ubc.ca/letter133

#MedEd

2/8 Lower #BloodPressure not the Main Goal

#Antihypertensives lower various measures of blood pressure (BP) 💊

But... not all BP lowering drugs are proven to reduce both morbidity & mortality

👉🏾ti.ubc.ca/letter133

#MedEd #prescribing #hypertension

3/8 The importance of clinical outcomes

Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes

Read our Therapeutics Letter on optimal 1st and 2nd line treatments: ti.ubc.ca/letter133

#MedEd #prescribing #hypertension

4/8 First best choice: Low dose thiazides

Evidence strongly points to thiazide/thiazide-like diuretics as best choice for 1⃣st-line tx, supported by @CochraneLibrary reviews.

This class reduces mortality, morbidity and is inexpensive

👉🏾More here: bit.ly/3HdFCVt

5/8 What about 2⃣nd choice #antihypertensives?

ACEIs vs ARBS:
Both drug classes reduce #BloodPressure to similar extents but only ACEIs have evidence for a reduction in risk of morbidity & mortality. So, they'd be your 2nd choice after low dose thiazides.

#MedEd #prescribing

6/8 Who should take an ARB?💊

Currently available evidence suggests we save ARBs for pts who cannot tolerate an ACEI

Up to 13% of pts experience cough associated with ACEIs, although only about 1-3% stop taking them

👉🏽More here: ti.ubc.ca/letter133

#MedEd #hypertension

7/8 Don’t Max Out: Don’t use more than ½ max dose of ACEI

✅Higher doses do NOT meaningfully reduce #BloodPressure further

✅½ of max dose of ACEI/ARB produces 90% & 80% of BP lowering of max dose, respectively

👉🏽Our Letter on dose titration: bit.ly/3G58QV7

#MedEd

8/8 Thiazides & skin cancer risk

We don't presently know whether thiazides cause skin cancer and are studying this association.

We maintain that at this time low dose thiazides are still 1st choice in reducing outcomes most important to pts

👉🏾More here: bit.ly/3olOu41

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